Renal carcinoma and dialysis in end-stage renal disease

We describe five patients receiving long-term hemodialysis (mean duration of 6.4 years) in whom eight renal carcinomas were found. In four patients, the carcinoma was confirmed by tissue pathology, while the fifth patient had multiple (four) areas of neovascularity on selective renal arteriography. Two patients died of metastases. In four patients the diagnosis was initially made with selective renal arteriography and in the remaining one, with sonography and computerized tomography. In three of the four arteriography showed diffuse cystic degeneration; pathologic findings revealed renal carcinoma and the changes of "end-stage" disease. Two patients had brief pharmacologic immunosuppression during unsuccessful renal transplantation six years earlier. These cases demonstrate an apparently increased risk of renal carcinomas in end-stage renal disease, a risk that appears to be independent of pharmacologic immunosuppression.