End-stage renal disease from renal metastases

Abstract

A 74-year-old female was admitted with end-stage renal disease (ESRD) for initiation of hemodialysis. Sixteen years earlier, an adenoid cystic carcinoma of Bartholin’s gland had been diagnosed and the patient had undergone hemivulvectomy. Two years later, surgery was performed to remove pulmonary metastases. Another 7 years later, bilateral renal metastases were found and she underwent bilateral partial nephrectomy. In addition, further pulmonary metastases were resected and she received radiotherapy for a rib metastasis. A computed tomography scan showed minimal progression of the lesions in the lung and kidneys (Figure 1). Despite treatment with liposomal doxorubicine, gemcitabine, and capecitabine, her disease progressed slowly with enlargement of the renal metastases and destruction of normal renal tissue (Figure 2). Fifteen years after the initial diagnosis, ESRD developed. Because the patient was in good physical and mental condition and wanted further treatment with dialysis, hemodialysis was started. After an uneventful 3 months, the patient complained of dyspnea caused by pulmonary metastases progression, and long-term oxygen therapy was initiated. She is still feeling well and satisfied with her treatment 4 months after commencement of dialysis.