Acquired Renal Cystic Disease Research Articles

Bilateral chromophobe renal cell carcinoma in an end-stage renal disease patient on haemodialysis

There is a well-known association between end-stage renal disease (ESRD) and the development of kidney cancer in the native kidney of patients requiring renal replacement therapy. There is now emerging evidence that lesser degrees of renal insufficiency (chronic kidney disease [CKD]) are also associated with an increased likelihood of cancer in general and kidney cancer in particular. Bilateral renal involvement by primary malignant processes is uncommon, although known to occur with Wilms tumours and in von Hippel–Lindau disease. Our patient is a 65-year-old female CKD, on haemodialysis for 8 years with bilateral renal tumours, underwent laparoscopic bilateral radical nephrectomy with histopathology reported as synchronous chromophobe bilateral renal cell carcinoma (RCC), which is the first case reported in the literature. In a study for 10 years on patients with CKD on haemodialysis, who developed acquired renal cystic disease (ARCD), there was an increase in the prevalence and severity of the ARCD as the dialysis continues over the years. Twenty per cent of patients dialysed for 1–3 years have ARCD, compared with >90% of patients dialysed for 5–10 years. In another study held at the Massachusetts General Hospital. They found that the occurrence of bilateral RCC is rare and found in only 1.8% of 329 patients who were treated RCC in 30 years. In a study published in the European Urology 2011. They also found that there are many favourable clinical, pathological and outcome features in the RCC accompanied with ESRD patients on dialysis which arising in the native kidneys compared with the RCC diagnosed in general population patients.

MP39-05 TRANSPOSON MUTAGENESIS DRIVES RENAL CYST FORMATION IN VIVO WHEN COMBINED WITH C-MET HYPERACTIVATION: IMPLICATIONS FOR ACQUIRED RENAL CYSTIC DISEASE

You have accessJournal of UrologyKidney Cancer: Basic Research & Pathophysiology I1 Apr 2017MP39-05 TRANSPOSON MUTAGENESIS DRIVES RENAL CYST FORMATION IN VIVO WHEN COMBINED WITH C-MET HYPERACTIVATION: IMPLICATIONS FOR ACQUIRED RENAL CYSTIC DISEASE Jason Scovell, Juan Hernandez, Adam Hollander, and Richard Link Jason ScovellJason Scovell More articles by this author , Juan HernandezJuan Hernandez More articles by this author , Adam HollanderAdam Hollander More articles by this author , and Richard LinkRichard Link More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1179AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Acquired renal cystic disease (ARCD) imparts a high risk for renal cell carcinoma (8%) in patients with end-stage renal disease. The molecular mechanism of cyst formation in ARCD remains unknown, although increased hepatocyte growth factor / C-MET signaling have been implicated in cyst formation. To explore molecular mechanisms of renal cyst development relevant to ARCD, we developed a murine model system based on tissue-selectable C-Met activation and transposon-mediated mutagenesis. METHODS To allow conditional activation of C-Met signaling, we engineered a tandem duplicated and mutated human C-MET coding sequence. Cre recombinase catalyzes exchange of the wild type C-Met locus with a constitutively active variant (M1248T). C-met+/M1248T mice were crossed with mice carrying the mutagenic Sleeping Beauty (Onc2) transposable element activated by a cre-dependent transposase (trpase). Localization to the renal epithelium was achieved by ggt-cre. Mice with activated C-Met and transposon mutagenesis (1: c-met+/M1248T; Onc2+/-, trpase+/-; ggt-cre+/-) were compared to mice with activated C-Met (2: c-met+/M1248T; ggt-cre+/-) or activated transposon mutagenesis (3: Onc2+/-, trpase+/-; ggt-cre+/-) alone. Mice were serial imaged by ultrasound and MRI. All kidneys were then examined grossly and histologically at necropsy after aging. RESULTS All mice (N=5) with both C-Met hyperactivation and transposon activity (1) developed large renal cysts by 6 months. No mice with only C-Met hyper-activation (2; N=10) or transposon activity (3; N=10) developed cysts by 6 months. Histological analysis demonstrated fluid filled and hemorrhagic renal cysts without evidence for malignancy. CONCLUSIONS C-Met hyperactivation is insufficient to drive renal cyst formation in isolation. Combining M1248T with transposon mutagenesis drove renal cyst formation with 100% penetrance. By mapping transposon insertion sites in cyst-lining epithelial cells in this model, we can now begin to isolate these interacting genes, which may improve our understanding of the molecular mechanisms underlying ARCD. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e494-e495 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jason Scovell More articles by this author Juan Hernandez More articles by this author Adam Hollander More articles by this author Richard Link More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

737 RENAL CELL CARCINOMA IN PATIENTS WITH END-STAGE RENAL DISEASE HAS FAVORABLE OVERALL PROGNOSIS

You have accessJournal of UrologyKidney Cancer: Evaluation & Staging (II)1 Apr 2013737 RENAL CELL CARCINOMA IN PATIENTS WITH END-STAGE RENAL DISEASE HAS FAVORABLE OVERALL PROGNOSIS Adam Shrewsberry, Adeboye Osunkoya, Kun Jiang, Ruth Westby, Daniel Canter, John Pattaras, Nicole Turgeon, Viraj Master, and Kenneth Ogan Adam ShrewsberryAdam Shrewsberry Atlanta, GA More articles by this author , Adeboye OsunkoyaAdeboye Osunkoya Atlanta, GA More articles by this author , Kun JiangKun Jiang Atlanta, GA More articles by this author , Ruth WestbyRuth Westby Atlanta, GA More articles by this author , Daniel CanterDaniel Canter Atlanta, GA More articles by this author , John PattarasJohn Pattaras Atlanta, GA More articles by this author , Nicole TurgeonNicole Turgeon Atlanta, GA More articles by this author , Viraj MasterViraj Master Atlanta, GA More articles by this author , and Kenneth OganKenneth Ogan Atlanta, GA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.300AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with end-stage renal disease (ESRD) demonstrate a greater risk for renal cell carcinoma (RCC) than the general population. Typically, patients undergoing transplant evaluation that are found to have a renal tumor are treated with nephrectomy prior to transplantation. We hypothesize that the prognosis of these patients is better than patients without ESRD and thus can avoid delayed transplantation. METHODS A total of 126 patients with renal tumors and ESRD that underwent nephrectomy since 1999 at our institution were retrospectively reviewed. Of these patients, 85 were found to have RCC, making up our cohort. These patients' charts as well as the charts of 238 control patients without ESRD-associated RCC were reviewed to determine baseline characteristics, pathologic staging, and overall mortality. RESULTS The ESRD group was younger (56.1 vs. 59.8 years, p=0.02), but had a higher mean age-adjusted Charleston Comorbidity Index (4.7 vs. 2.7, p<0.001). Eleven of the ESRD patients versus 5 of the control patients had bilateral nephrectomies. Average time on dialysis was 4.45 +/- 4.72 years with 68% having radiographic evidence of acquired renal cystic disease (ARCD). Thirty-one percent of patients eventually underwent transplantation. In the ESRD patients, 90.6% had T1 or T2 disease compared with 73.3% in the control group (p<0.001). Kidneys in the control group were more likely to have clear cell RCC (73.3% vs. 36.5%, p<0.001) whereas kidneys in the ESRD group were more likely to have papillary RCC (38.5% vs. 16.0%, p<0.001). Fifty-three percent of patients with ESRD had Fuhrman grade 1 or 2 tumors compared to 47% in the control group (p=0.43). Average Karakiewicz nomogram score was 49.6 in the ESRD group versus 88.8 in the control group (p<0.001). At a mean follow-up of 1.8 years and 3.3 years for the ESRD and control groups, respectively, recurrence rates were 3.1% versus 16.8%, (p=0.004). There was no difference in overall mortality between the two groups (26% vs. 33%, p=0.25). CONCLUSIONS Patients with ESRD who develop RCC have a better prognosis compared to RCC in the general population. Thus, the standard delay between nephrectomy and renal transplantation may not be necessary. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e303 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Adam Shrewsberry Atlanta, GA More articles by this author Adeboye Osunkoya Atlanta, GA More articles by this author Kun Jiang Atlanta, GA More articles by this author Ruth Westby Atlanta, GA More articles by this author Daniel Canter Atlanta, GA More articles by this author John Pattaras Atlanta, GA More articles by this author Nicole Turgeon Atlanta, GA More articles by this author Viraj Master Atlanta, GA More articles by this author Kenneth Ogan Atlanta, GA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Computed tomography of renal cell carcinoma in patients with terminal renal impairment

An increased incidence of renal tumors has been observed in patients with end-stage-renal-disease (ESRD). The very strong association with acquired renal cystic disease (ACRD) and increased incidence of the renal tumors (conventional renal cell carcinoma (CRCC), papillary renal cell carcinoma (PRCC) or papillary renal cell adenoma (PRCA)) was reported. This study discusses the role of computed tomography (CT) in detecting renal tumors in patients with renal impairment: pre-dialysis, those receiving dialysis or with renal allograft transplants. Ten patients (nine male, one female) with renal cell tumors were enrolled into a retrospective study; two were new dialysis patients, three on long-term dialysis, and five were renal transplant recipients with history of dialysis. All patients underwent helical CT, a total of 11 procedures were performed. Sixteen-row detector system was used five times, and a 64-row detector system for the six examinations. All patients underwent nephrectomy of kidney with suspected tumor, 15 nephrectomies were performed, and 1 kidney was assessed during autopsy. CT findings were compared with macroscopic and microscopic assessments of the kidney specimen in 16 cases. Very advanced renal parenchyma atrophy with small cysts corresponding to ESRD was found in nine patients, chronic pyelonephritis in remained one. A spontaneously ruptured tumor was detected incidentally in one case, patient died 2 years later. In the present study, 6.25% (1/16) were multiple PRCA, 12.5% (2/16) were solitary PRCC, 12.5% tumors (2/16) were solitary conventional renal cell carcinomas (CRCC's), 12.5% tumors (2/16) were multiple conventional renal cell carcinomas (CRCC's), 25% (4/16) were CRCC's combined with multiple papillary renal cell carcinomas with adenomas (PRCC's and PRCA's), and 25% (4/16) of the tumors were multiple PRCC's combined with PRCA's without coexisting CRCC's. Bilateral renal tumors were found in our study in 60% (6/10) confirmed in six cases, one kidney left on follow-up due to the small tumors. With the use of a multi-detector row system, it is possible to detect smaller foci suspected to originate in multiple tumors, especially when up to 3-mm thin multi-planar reconstructions are used. Two cases demonstrated the possibility the development of RCC in impaired kidneys may start before dialysis initiation.

EXPRESSION OF HEPATOCYTE GROWTH FACTOR AND ITS RECEPTOR C-MET IN ACQUIRED RENAL CYSTIC DISEASE ASSOCIATED WITH RENAL CELL CARCINOMA

The development of renal cell carcinoma (RCC) is a critical problem in acquired renal cystic disease (ARCD) in patients with end stage renal disease, particularly males on chronic hemodialysis. We examined the expression of hepatcyte growth factor (HGF) and its receptor c-met in ARCD associated with RCC to elucidate the role of the HGF/c-met pathway in renal cyst development and subsequent tumor transformation. Immunohistochemical expression of HGF, c-met and Bcl-2 was examined in 15 normal tissue samples of kidneys obtained from nephrectomy for localized RCC and 19 with ARCD associated with RCC from 16 patients on dialysis. The expression of HGF mRNA was examined by reverse transcriptase-polymerase chain reaction. In normal kidneys immunostaining for HGF was scarcely detected in renal tubular cells. Bcl-2 and c-met immunostaining was observed mainly in distal tubular cells. In nontumor areas of kidneys with ARCD associated RCC the expression of HGF and c-met was up-regulated in tubular and the cyst epithelial cells. Hyperplastic cysts with multilayer epithelium and micropapillary projection were the predominant cysts stained with HGF and c-met. Immunostaining for HGF and c-met was also detected in RCC regions. The Bcl-2 immunostaining pattern was similar to that of HGF and c-met in nontumor and RCC regions. On reverse transcriptase-polymerase chain reaction HGF mRNA expression was up-regulated in nontumor areas and RCC regions in ARCD. These results suggest that up-regulation of HGF and its receptor c-met may be involved in renal cyst formation and subsequent tumor transformation in patients with end stage renal disease. Increased Bcl-2 expression may promote this process through the inhibition of apoptosis.

Atypical epithelial proliferations in acquired renal cystic disease harbor cytogenetic aberrations

Acquired renal cystic disease (ARCD) complicating end-stage renal failure confers an increased risk for renal cell carcinoma, and atypical epithelial proliferation in the cysts may represent the precursor lesion. In this report we used an interphase cytogenetic technique to analyze the karyotypic features of various forms of atypical epithelial proliferations in a patient with ARCD. Both kidneys harbored numerous simple and atypical cysts. In addition, papillary tufts and a hitherto undescribed cribriform epithelial proliferation were found in the right kidney. The left kidney contained a 10-mm renal cell carcinoma with features indeterminate between clear cell and papillary types. There was gain of chromosome 7 in the papillary tufts; gain of chromosomes 7 and 17 in the cribriform lesion; gain of chromosomes 7, 12, 17, 20, and Y in the atypical cysts; and gain of chromosomes 7, 12, 17, and 20 in the renal cell carcinoma. These chromosomal aberrations suggest that atypical epithelial proliferations in ARCD represent early neoplastic lesions. HUM PATHOL 33:761-765. Copyright 2002, Elsevier Science (USA). All rights reserved.

Prevalence of renal cell carcinoma in patients with ESRD pre-transplantation: A pathologic analysis

Acquired renal cystic disease (ARCD), renal adenoma (AD), and renal cell carcinoma (RCC) are more common in patients with end-stage renal disease (ESRD). However, the prevalence of these conditions in patients undergoing transplantation, and the clinical characteristics associated with their occurrence are unclear. At our institution, the majority of patients undergo an ipsilateral native nephrectomy at the time of transplantation, providing a unique opportunity to study the prevalence and pathology of ARCD, AD and RCC in ESRD. We retrospectively reviewed all consecutive nephrectomy pathology reports over a six year period. Demographic and clinical characteristics associated with these lesions were identified. Two hundred and sixty nephrectomy reports were reviewed: ARCD, AD, RCC and oncocytoma were found in 33%, 14%, 4.2% and 0.6% of cases, respectively. On multivariable analysis, ARCD was positively associated with male sex and longer dialysis duration and negatively associated with peritoneal dialysis. Similarly, AD was positively associated with male sex, longer dialysis duration and greater age. There was a trend for RCC cases to share similar associations although the small total number of cases precluded findings of statistical significance. By pathologic analysis, renal tumors are more common in the pre-transplant ESRD population than previously reported (using radiologic methods). Our study also identifies risk factors for their occurrence. This may prove useful in designing screening studies for renal tumors in this patient population.

Chromosomal abnormalities in renal cell neoplasms associated with acquired renal cystic disease. A series studied by comparative genomic hybridization and fluorescencein situ hybridization

Sporadic renal cell carcinomas (RCCs) display different chromosomal abnormalities according to their morphology; gains of chromosomes 7 and 17 and loss of Y are commonly observed in papillary lesions, whereas loss of 3p sequences and multiple losses of specific chromosomes are found in non-papillary and chromophobe cell carcinomas, respectively. Acquired renal cystic disease (ARCD) is associated with an increased incidence of renal cell tumours, especially papillary lesions. The aim of this study was to examine a series of ARCD-related tumours for chromosomal abnormalities and to compare the findings with those abnormalities commonly observed in sporadic RCCs. Nine tumours from four patients with ARCD were examined using comparative genomic hybridization (CGH) and interphase cytogenetics. Gain of chromosomes 7 and 17 was observed in all four papillary lesions and loss of Y in three. In addition, gain of chromosome 16 was observed in three papillary tumours. Three chromophobe RCCs originating from the same kidney showed different genomic profiles; two had no abnormalities, whereas one showed loss of chromosome 17p. Two non-papillary RCCs failed to show chromosome 3p alterations. In conclusion, renal cell tumours developing in ARCD may show chromosomal abnormalities both similar to and different from those seen in sporadic tumours.

Acquired renal cystic disease in children and young adults on maintenance dialysis.

Acquired renal cystic disease (ARCD) is a well-known complication of end-stage renal disease (ESRD). We studied 24 patients, aged 8-27 years (mean 19.8 +/- 5.3 years), on chronic maintenance dialysis in our service. The duration of dialysis ranged between 13 and 192 months (mean 77.8 +/- 44.3 months). High-resolution ultrasonography revealed ARCD in 11 (45.8%) patients. No cysts were seen in 7 (29.1%) patients and solitary cysts in one or both kidneys were seen in 6 (25%) patients. Renal malignancy was diagnosed in 2 patients. One, 15 years old, had renal cell carcinoma after being on dialysis for 6 years. She did well after bilateral nephrectomy, left salpingo-oophorectomy, and regional lymphadenectomy. The second patient, 23 years old, had been on dialysis for 16 years when she developed renal oncocytoma. She died of congestive cardiomyopathy 6 months later. We conclude that ARCD is common in children and young adults with ESRD. Neoplastic transformation, although rare, is a potential complication. Annual follow-up with ultrasonography with selective use of computed tomography or magnetic resonance imaging is advised.

Acquired Renal Cystic Disease and Tumor Markers in Chronic Hemodialysis Patients

Acquired renal cystic disease (ARCD) is a well documented complication of end-stage renal disease, and it has been related to the duration of dialysis therapy. The association of this condition with renal cell adenoma or carcinoma has already been established. There have also been studies on the concentration of some tumor markers in hemodialysis (HD) patients, clinically free from neoplastic disease, where it was concluded that some tumor markers could be elevated, despite the absence of malignant disease, suggesting their altered metabolism i.e. clearance by the hemodialysis membrane. We compared the pre-dialysis serum concentration of several tumor markers in three groups of chronic HD patients, all of whom had been on maintenance HD treatment for more than 5 years. Group 1 consisted of 16 patients without ARCD with a mean HD treatment duration of 97.06 +/- 28.25 months. Group 2 consisted of 32 patients with a mean HD treatment of 105.62 +/- 24.4 months, who had ARCD with less than 10 renal cysts detected by ultrasonography. Group 3 consisted of 14 patients with a mean HD duration of 109.92 +/- 37.72 months, with ARCD and more than 10 renal cysts. Concentration of the following tumor markers was determined by EIA or ELISA methods: carcinoembryonic antigen (CEA), mucin-like carcinoma-associated antigen (MCA), neuron-specific enolase (NSE), carbohydrate antigen 19-9 (CA 19-9), prostatic specific antigen (PSA), carbohydrate antigen 125 (CA 125), alpha fetoprotein (AFP), cytokeratin 19-fragments 21-1 (CYFRA 21-1). The concentration of all the tumor markers was comparable in all three patient groups, with no statistically significant difference between groups. The mean concentrations of MCA, PSA, CA 125 and AFP were within the normal range. CEA and CYFRA 21-1 had mean values in the upper limit of their normal values, while NSE and CA 19-9 were increased by more than twofold in all three patient groups. We concluded that (i) tumor markers should be used with caution when diagnosing neoplastic diseases in chronic HD patients, because of their altered metabolism, and (ii) that in the follow up of ARCD with possible neoplastic alteration, imaging techniques remain dominant diagnostic tools.

Unilateral acquired renal cystic diseas and neoplasia in a patient with renal artery stenosis

We report a case of a sixty-two-year-old woman with longstanding unilateral renal artery stenosis in whom acquired renal cystic disease (ARCD) and neoplasia developed. ARCD has been frequently reported in the hemodialysis and peritoneal dialysis patients, but rarely reported in the nonuremic patient. To our knowledge it has not been previously reported in a patient with unilateral renal artery stenosis.

Acquired renal cystic disease in children prior to the start of dialysis.

This report describes the clinical course and serial sonographic findings in three children who developed acquired renal cystic disease (ARCD) prior to the institution of dialysis. The children were aged from 3 years to 13 years and their estimated glomerular filtration rate varied from 8 to 13 ml/min per 1.73 m2 when ARCD was diagnosed. Their primary renal disorders, which included hemolytic-uremic syndrome and focal segmental glomerulosclerosis, had been present for 1.5-11.5 years prior to the cysts being discovered. These patients show that ARCD may develop in children with chronic progressive renal parenchymal disease prior to the institution of specific therapy for end-stage renal disease.

Neoplasia and acquired renal cysticdisease in patients undergoing chronic ambulatory peritoneal dialysis

Acquired renal cystic disease (ARCD) was initially reported to occur exclusively with patients on chronic hemodialysis for end-stage renal disease, To date, no cases of ARCD have been well documented in patients with end-stage renal disease treated solely by peritoneal dialysis. We report the occurrence of ARCD with renal cell carcinoma and hemorrhagic cyst formation in 2 patients with end-stage renal disease treated only with chronic ambulatory peritoneal dialysis for three and one-half and three years, respectively, since the onset of their renal failure. Both patients were found to have ARCD and complex masses on follow-up ultrasound examination after previous normal examinations. The findings were confirmed by computerized tomography (C T) scan and both patients underwent radical nephrectomy.

Acquired Renal Cystic Disease: Two Cases of Associated Adenocarcinoma and a Renal Ultrasound Survey of a Peritoneal Dialysis Population

Long-term dialysis patients frequently develop acquired renal cystic disease (ARCD). The discovery of ARCD and renal cell carcinoma in one of our hemodialysis patients led us to review the literature. ARCD has been described mainly in the maintenance hemodialysis (MH) population. Therefore, we investigated 20 peritoneal dialysis (PD) patients for ARCD using ultrasonography. Seven patients (35%) had detectable cysts and two patients (10%) had multiple bilateral cysts. One patient had a large asymptomatic complex cyst that proved to be an adenocarcinoma. Our study suggests that ARCD is relatively common in the PD population, and we speculate that it may be related more to length of time in end-stage renal disease (ESRD) than to the mode of dialysis. The potential for malignant change appears to justify a routine screening examination with ultrasonography and/or computerized tomography (CT) to detect this recently described and probably underrecognized entity.

590 - The Presence of a Growth Factor in Cyst Fluid from Patients with Acquired Renal Cystic Disease (ARCD)

No AccessJournal of Urology1 Jun 1987The Presence of a Growth Factor in Cyst Fluid from Patients with Acquired Renal Cystic Disease (ARCD) Ralph J. Torrence, Jeff D. Elbers, and Ralph V. Clayman Ralph J. TorrenceRalph J. Torrence More articles by this author , Jeff D. ElbersJeff D. Elbers More articles by this author , and Ralph V. ClaymanRalph V. Clayman More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)75740-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "The Presence of a Growth Factor in Cyst Fluid from Patients with Acquired Renal Cystic Disease (ARCD)." The Journal of Urology, 137(6), p. 251A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 6June 1987Page: 251A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Ralph J. Torrence More articles by this author Jeff D. Elbers More articles by this author Ralph V. Clayman More articles by this author Expand All Advertisement PDF DownloadLoading ...

Measurement of phthalates in small samples of mammalian tissue.

Di-(2-ethylhexyl)-phthalate (DEHP) is a phthalic acid ester that is used as a plasticizer in polyvinyl chloride products, many of which have widespread medical application. DEHP has been shown to be leached from products used for storage and delivery of blood transfusions during procedures such as plasmaphoresis, hemodialysis and open heart surgery. Results of studies in this laboratory have suggested that there is an association between the absorption and deposition of DEHP (and/or related chemicals) in the kidney and the acquired renal cystic disease (ACD) frequently seen in patients who have undergone prolonged dialysis treatment. In order to determine the relationship between the two, it has been necessary to establish a method for extracting and accurately quantitating minute amounts of these chemicals in small tissue samples. The authors have now established such a method using kidneys from normal rats and from a rat model for ACD.

Clinical characteristics and diagnostic considerations in acquired renal cystic disease

Acquired multiple bilateral cystic transformation of kidneys has been increasingly noted in patients with long-standing renal failure treated by chronic dialysis. To study the clinical characteristics of this newly described disease and assess the utility of available diagnostic methods, 130 patients with chronic renal failure (100 on dialysis, 30 nondialyzed) were studied with ultrasonography and/or computerized tomography (CT). Among patients on dialysis, 22% had acquired renal cystic disease (ARCD), an additional 30% had one to three solitary cysts, and 48% had no cysts. In nondialyzed patients, 7% had ARCD, 53% had one to three solitary cysts, and 40% had no cysts. Among these 130 chronic renal failure patients (nondialyzed and dialyzed), 21 of 86 males compared to 1 of 44 females had ARCD (P less than 0.001). Duration of dialysis therapy and age were greater in patients with ARCD (49.8 +/- 8 months, 55 +/- 4 years, respectively) compared to those with solitary cysts (28 +/- 6 months, 45 +/- 2 years) or no cysts (15 +/- 3 months, 42 +/- 2 years). The diagnostic accuracy of ultrasound (US) was compared to CT. CT is purportedly 100% accurate in the characterization of renal cysts. We are disappointed at the low level of diagnostic accuracy for both CT and US in the detection of renal cysts in chronic uremia. It appears both a negative CT and ultrasound are necessary to absolutely exclude either ARCD or solitary cyst.

Acquired renal cystic disease in renal transplant recipients.

End-stage kidneys are known to undergo cystic transformation in patients treated with long-term hemodialysis. Little has been published, however, on the occurrence of acquired renal cystic disease (ACD) in renal transplant recipients. The available clinical and histopathological data were gathered on 22 renal transplant recipients who had undergone either necropsy or nephrectomy. None of our patients exhibited cystic changes in their donor kidneys. However, 11 patients (50%) had ACD of the native kidneys while the remaining patients lacked ACD. The duration of dialysis prior to transplantation was significantly longer and the life of the functional transplant kidney was significantly shorter in the ACD group as compared to the noncystic group. The combined duration of ESRD (dialysis + transplantation), however, was comparable in the two groups. It thus appears that the presence of a functioning renal allograft somehow retards the evolution of cystic changes in the diseased native kidneys. 1 of the patients in the ACD group exhibited superimposed multifocal clear cell carcinoma of the affected kidney, while none of the patients in the noncystic group exhibited renal neoplasm.