End-stage Kidney Research Articles

An Analysis of Elderly End-stage Chronic Kidney Disease Patients Who Did Not Undergo Renal Replacement Therapy in Japan

There is little descriptive information regarding the conservative management of Japanese end-stage chronic kidney disease (CKD) patients. We carried out a retrospective case series analysis of elderly Japanese end-stage CKD patients who were hospitalized and died without the provision of renal replacement therapy (RRT) programs. A total of 25 consecutive patients followed by a nephrologist for a median of 443 days with a mean age of 81.7 ± 7.5 years were included. The most common symptom on admission was appetite loss in 17 patients (68%). Fifty percent of the patients died within 394 days of follow-up after their estimated glomerular filtration rate (eGFR) fell below 15 mL/min/1.73 m2 and 222 days of follow-up after the eGFR fell below 10 mL/min/1.73 m2. The validity of our findings for Japanese patients with end-stage CKD must be evaluated in greater detail.

An Assessment of HIV-Infected Patients Dying in Care for Deceased Organ Donation in a United States Urban Center

Organ transplantation is an acceptable option for human immunodeficiency virus (HIV)-infected patients with end-stage kidney or liver disease. With worse outcomes on the waitlist, HIV-infected patients may actually be disproportionately affected by the organ shortage in the United States. One potential solution is the use of HIV-infected deceased donors (HIVDD), recently legalized by the HIV Organ Policy Equity (HOPE) Act. This is the first analysis of patient-specific data from potential HIVDD, retrospectively examining charts of HIV-infected patients dying in care at six HIV clinics in Philadelphia, Pennsylvania from January 1, 2009 to June 30, 2014. Our data suggest that there are four to five potential HIVDD dying in Philadelphia annually who might yield two to three kidneys and three to five livers for transplant. Extrapolated nationally, this would approximate 356 potential HIVDD yielding 192 kidneys and 247 livers annually. However, several donor risk indices raise concerns about the quality of kidneys that could be recovered from HIVDD as a result of older donor age and comorbidities. On the other hand, livers from these potential HIVDD are of similar quality to HIV-negative donors dying locally, although there is a high prevalence of positive hepatitis C antibody.

The Challenges and Promise of HIV-Infected Donors for Solid Organ Transplantation.

Solid organ transplantation is now the standard of care for many HIV-infected patients with end-stage kidney or liver disease. There is an overall organ shortage that affects all transplant candidates, including those with HIV. The use of HIV-infected donors could help alleviate this shortage. The precedent for this approach was set in South Africa, where promising short-term outcomes have been reported in a limited number of HIV-infected recipients of kidney transplants from HIV-infected donors. As a consequence, the HIV Organ Policy Equity (HOPE) Act was passed in the United States, legalizing research into HIV-infected organ donation. In this review, we discuss some of the key issues related to HIV-infected organ donation, including the need for transplant in HIV-infected populations, characterization of the potential donor pool in the USA, criteria for donor selection, concerns specific to the HIV-infected donor, the ethics of HIV-infected organ donation, and the next steps toward making HIV-infected donation a reality in the USA.

Acute Kidney Injury in the Critically Ill Patient: A Current Review of the Literature.

A comprehensive review of the literature to provide a focused and thorough update on the issue of acute kidney injury (AKI) in the surgical patient. A PubMed and Medline search was performed and keywords included AKI, renal failure, critically ill, and renal replacement therapy (RRT). A common clinical problem encountered in critically ill patients is AKI. The recent consensus definitions for the diagnosis and classification of AKI (ie, Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease/Acute Kidney Injury Network) have enabled us to standardize the severity of AKI and facilitate strategies for prevention. These strategies as well as treatment modalities of AKI are discussed. We provide a concise overview of the issue of renal failure. We describe strategies for prevention including types of fluids used for resuscitation, timing of initiation of RRT, and different treatment modalities currently available for clinical practice. Acute kidney injury is a common problem in the critically ill patient and is associated with worse clinical outcomes. A standardized definition and staging system has led to improved diagnosis and understanding of the pathophysiology of AKI. There are many trials leading to improved prevention and management of the disease.

CHARACTERIZING CHRONIC MYOCARDIAL INFARCTIONS IN PATIENTS USING NATIVE T1-BASED CARDIOVASCULAR MAGNETIC RESONANCE

Late Gadolinium Enhancement (LGE) Cardiovascular Magnetic Resonance (CMR) is the gold standard for characterizing chronic myocardial infarctions (CMIs), but it is contraindicated in patients with end-stage chronic kidney disease. We investigated whether native T1 mapping at 3T can reliably

Contrast induced acute kidney injury in acute coronary syndrome patients: A single centre experience

The aim of the study was to investigate predictors of contrast induced acute kidney injury, in-hospital and long-term mortality in patients with acute coronary syndrome treated by percutaneous coronary intervention. We investigated 536 consecutive patients with acute coronary syndrome who underwent percutaneous coronary intervention. Contrast induced acute kidney injury was classified according to risk, injury, failure, loss of kidney function and end-stage kidney disease/acute kidney injury network (RIFLE/AKIN) criteria into those with normal kidney function, risk, RIFLE stage I and those with stage ⩾ II. We investigated in-hospital, all-cause mortality during index hospitalization and long-term all-cause mortality during the follow-up period of 94 months (interquartile 81.6-108.9 months) in adjustment with parameters of the Global Risk of Acute Coronary Events score. Patients with contrast induced acute kidney injury had worse baseline clinical characteristics and displayed more co-morbidities than patients with normal kidney function. In multivariate logistic regression analysis intra-aortic balloon pump use, congestive heart failure, age >75 years and admission serum creatinine >1.5mg/dl were independent predictors of contrast induced acute kidney injury development. contrast induced acute kidney injury RIFLE stage ⩾ II was an independent predictor of in-hospital mortality (odds ratio 33.16, confidence interval 1.426-770.79, p=0.029) and long-term mortality (hazard ratio 4.713, confidence interval 1.53-14.51, p=0.007) even after adjustment for confounders (variables of Global Risk of Acute Coronary Events score). Contrast induced acute kidney injury is a common complication of acute coronary syndrome patients treated by percutaneous coronary intervention. Advanced deterioration in renal function after percutaneous coronary intervention is an independent predictor for in-hospital and long-term mortality.

Sitting Here in Limbo: The Saga of End-Stage Renal Failure and Kidney Transplantation in the United States

This paper aims to evaluate the role that personal appeals for organ donations have played throughout the history of transplantation, with particular attention to the diverse relationships such appeals have had with public policy regarding organ transplantation — at times seeming to animate policy developments, while at other times assuming an antagonistic role vis-a-vis the medical and legal establishments — and the further ethical issues implicated by the advent of social media as a tool to facilitate these exchanges. In Part I, I will recount the history of modern treatment for kidney disease, and how its development set up a paradigm that deeply entwined the federal government and the medical establishment. I will discuss the complex history of the earliest widely-used treatment for kidney failure — dialysis — paying special attention to the issues of scarcity and allocation that have complicated this treatment since the opening of the first long-term dialysis clinics in the early 1960s. I will discuss how the success of kidney transplantation created new problems of supply and demand that resemble those associated with dialysis in the past. I will recount the history of legislation related to kidney disease and organ donation, including a discussion of the role that personal emotional appeals have played in shaping public policy related to the treatment of kidney disease, even before transplantation became the preferred method of treatment. In Part II, I will provide statistics to illustrate the gravity of the issues that characterize our current system of regulating organ transplantation. Then, I will describe the values that motivate our organ donation and allocation system, and the conflicts they can engender. In Part III, I aim to further elucidate the profound moral issues implicated in organ transplantation by discussing the experience of having end stage renal disease, and relating the reality of this experience to an analysis of the rhetoric surrounding kidney transplantation in the United States. Part IV will address various issues concerning directed donations from living organ donors. First, I will discuss the notable absence of regulation with regard to organ donations from living donors, explaining why this regulatory gap exists, and how it has led to further controversy and dysfunction within the organ transplantation system. Second, I will discuss concerns unique to living kidney donation, and how the medical and legal establishments have responded to these concerns in crafting the transplant process as it operates today. Next, I will analyze trends in living donation, specifically the increasing popularity of non-related directed donations. I will discuss the ethical issues implicated in this trend, including the permissibility of directed donation, how certain types of directed donation conflict with the values that constitute the backbone of our current organ transplantation system, and the question of risk to both donor and recipient. I will then specifically address the role of social media and the Internet in facilitating this trend, and the ways in which new social media platforms to facilitate living donation may serve to exacerbate inequalities in organ allocation. In Part V, I will propose a way to harness the power of social media in order to facilitate increased donation, and make several suggestions for improving our policy regarding living organ donation.

Assessment of oral and periodontal parameters in patients with end-stage chronic kidney disease

Aim: The purpose of the study was to assess the oral cavity status in patients with terminal chronic kidney disease (CKD) undergoing haemodialysis. Materials and Methods: The study comprised 69 patients with end-stage CKD undergoing haemodialysis regime. The data regarding the age, gender, environment, associated diseases were obtained from the clinical medical histories. The patients were submitted to clinical examination, which also included the periodontal probing and the gingival bleeding assessment. The type of edentulous ridge was recorded. Each patient filled a questionnaire offering data regarding the oral hygiene habits, diet, bad habits and the presence/absence of xerostomia. Results and Discussion: The main cause for end-stage CKD was renal, followed by diabetes mellitus and arterial hypertension. The main associated diseases to CKD were clearly secondary arterial hypertension and secondary anaemia; other associated diseases were represented by cardiac diseases, hepatitis, gastro-intestinal diseases, secondary hyperparathyroidism, cirrhosis, hypersplenism, epilepsy and neoplastic diseases. 62.31% of the patients accused frequent xerostomia. When recording the edentulous type, we observed a high percentage of complete tooth loss. Conclusions: There is a close link between the systemic changes in the CKD patient and the oral manifestations. Even 2 of the main causes of CKD (hypertension and diabetes mellitus) exert important changes on the tissues in the oral cavity, leading to significant tooth loss and masticatory impairment, thus, to a poor quality of life.

Abstract 13610: Native T1-based Cardiovascular Magnetic Resonance Imaging for Characterizing Chronic Myocardial Infarctions in Patients

Introduction: Late Gadolinium Enhancement (LGE) Cardiovascular Magnetic Resonance (CMR) is the gold standard for characterizing chronic myocardial infarctions (MIs), but it is contraindicated in patients with end-stage chronic kidney disease. Hypothesis: We investigated whether native T1 mapping at 3T can reliably characterize chronic MIs in two pilot patient populations with prior STEMI and NSTEMI. Methods: Patients with prior STEMI (n=15) and NSTEMI (n=17) underwent CMR at a median of 13.6 years after acute MI and native T1 maps and LGE images were acquired. Infarct location, size and transmurality were measured from LGE and T1 maps using standard threshold criterion and compared against one another. Visual conspicuity for detecting chronic MI territories on LGE images and T1 maps were assessed by independent reviewers. Results: LGE images and native T1 maps were not different for measuring infarct size (STEMI: p=0.87; NSTEMI: p=0.93) and transmurality (STEMI: p=0.19; NSTEMI: p=0.24). Statistical analyses showed good agreement between LGE images and T1 maps for measuring infarct size (STEMI: bias = -0.4±2.1%; R2=0.97; NSTEMI: bias = -1.1±3.9%; R2=0.87) and transmurality (STEMI: bias = 1.5±2.9%; R2=0.99; NSTEMI: bias = -2.2±7.4%; R2=0.71). Sensitivity and specificity of native T1 maps for detecting chronic MIs based on threshold criterion were 93% and 97% respectively (STEMI); and 93% and 92% respectively (NSTEMI). Mean visual conspicuity score for detecting chronic MI on LGE images was greater than that of native T1 maps (p<0.001). Sensitivity and specificity of native T1 maps using visual detection were: 61% and 85% (STEMI); and 67% and 90% (NSTEMI). Conclusions: Chronic MIs in STEMI and NSTEMI patients can be reliably characterized using threshold-based detection with native T1 maps when the location of remote myocardium is known. The current visual detectability of remote myocardium on native T1 maps has a certainty of 85% in STEMI and 90% in NSTEMI patients.

P108: The Multidimensional Prognostic Index (MPI) predicts mortality in older patients with end-stage chronic kidney disease (CKD) on haemodialysis

P108: The Multidimensional Prognostic Index (MPI) predicts mortality in older patients with end-stage chronic kidney disease (CKD) on haemodialysis

Acute kidney injury in major gynaecological surgery: an observational study.

To assess the prevalence, outcomes and cost associated with acute kidney injury (AKI) defined by consensus risk, injury, failure, loss, and end-stage kidney (RIFLE) criteria after gynaecologic surgery. Retrospective single-centre cohort study. Academic medical centre. Two thousand three hundred and forty-one adult women undergoing major inpatient gynaecologic surgery between January 2000 and November 2010. AKI was defined by RIFLE criteria as an increase in serum creatinine greater than or equal to 50% from the reference creatinine. We used multivariable regression analyses to determine the association between perioperative factors, AKI, mortality and cost. AKI, combined major adverse events (hospital mortality, sepsis or mechanical ventilation), 90-day mortality and hospital cost. Overall prevalence of AKI was 13%. The prevalence of AKI was associated with the primary diagnosis. Of women with benign tumour surgeries, 5% (43/801) experienced AKI compared with 18% (211/1159) of women with malignant disease (P < 0.001). Only 1.3% of the whole cohort had evidence of urologic mechanical injury. In a multivariable logistic regression analysis, AKI patients had nine times the odds of a major adverse event compared to patients without AKI (adjusted odds ratio 8.95, 95% confidence interval 5.27-15.22). We have identified several readily available perioperative factors that can be used to identify patients at high risk for AKI after in-hospital gynaecologic surgery. AKI is a common complication after major inpatient gynaecologic surgery associated with an increase in resource utilisation and hospital cost, morbidity and mortality.

Comparative assessment of parathyroid hormone and bone turnover markers in diabetic and non-diabetic patients with end-stage chronic kidney disease

Comparative assessment of parathyroid hormone and bone turnover markers in diabetic and non-diabetic patients with end-stage chronic kidney disease

Long-term outcomes of community-acquired versus hospital-acquired acute kidney injury: a retrospective analysis

To compare long-term outcomes in CA-AKI to HA-AKI. The hypothesis was that renal and patient survival would be better in CA-AKI than in HA-AKI. Retrospective cohort analysis of patients hospitalized from 2004 to 2005, in Upstate New York Veterans Affairs hospitals. The groups: CA-AKI (n = 560), HA-AKI (n = 158), or No AKI (NA) (n = 2,320). Risk, injury, failure, loss, and end-stage kidney (RIFLE) criterion was used to define AKI. doubling of serum creatinine, endstage renal disease (ESRD), death, and a composite of the three. de novo chronic kidney disease (CKD), recovery of renal function, and re-admission rate. The cumulative incidence of outcomes was determined over a period of 3 years after discharge. CA-AKI was 3.5 times as prevalent as HA-AKI. In comparison to patients with HA-AKI, those with CA-AKI had better estimated glomerular filtration rate (71.3 vs. 61.1 mL/min/1.73 m(2), p < 0.001) and lower prevalence of CKD (42.3 vs. 51.9%, p = 0.03) at baseline. More patients with CA-AKI than HA-AKI met RIFLE failure criterion (43.8 vs. 29.1%, p < 0.001). By 3 years, no differences were found for the individual primary and secondary outcomes tested (all p > 0.05). CA-AKI was found to be considerably more common than HA-AKI and had similar long-term consequences.

Hemolytic Anemia with Fragmented Red Blood Cells Following Vascular Access Grafting for Hemodialysis in a Patient with Chronic Kidney Disease

A 57-year-old male who had been treated with hemodialysis due to end-stage chronic kidney disease for 3 years received arterio-venous bypass grafting with a polyurethane vascular access graft in his left upper arm. Two months later, he was diagnosed with hemolytic anemia with fragmented red blood cells (RBC). He had never shown clinical symptoms such as fever or neurological abnormalities characteristic of thrombotic thrombocytopenic purpura (TTP). Moreover, neither thrombocytopenia nor coagulation abnormality was found on routine laboratory examination. He received arterial banding to reduce the blood flow entering the artificial vascular access graft, which led to rapid recovery from hemolytic anemia, without recurrence. This was an extremely rare case of angiopathic hemolytic anemia with fragmented RBC caused by unfavorable bypass grafting, successfully treated with simple reoperation to reduce the blood flow entering the vascular access graft.

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Introduction: Severe Sepsis (SS) and acute kidney injury (AKI) are costly postoperative complications that frequently occur together. Cost burden of SS has been extensively studied; the increased cost of concurrent SS and AKI less so. Methods: This was a retrospective cohort study of 50,314 adult patients with previously normal renal function undergoing surgical procedures requiring > 48 hours admission. SS was defined using the Agency for Healthcare Research and Quality (AHRQ) patient safety indicators "Postoperative Sepsis". Risk, Injury, Failure, Loss, and End-stage Kidney (RIFLE) consensus criteria and serial serum creatinine measurements were used to define AKI. We modeled the primary outcome variable, inflation adjusted hospital cost, as a function of common postoperative complications. All models were adjusted for hospital stay characteristics and validated using validation datasets. Adjusted costs for patients with and without each postoperative complication and 95% confidence intervals were calculated for each. Hospital cost was log transformed due to skewness. Smearing estimates were used to correct for bias when estimates were back-transformed. Results: Average cost per patient with no complications was $15,600 (95%CI: $15,500-$15,700). AKI occurred in 35% of patients with average cost per patient of $24,300 (95%CI: $23,900, 24,600); SS 4.8% with average cost per patient of $31,200 (95%CI: $24,700, $37,700). 94% of patients with SS had concurrent AKI with average cost per patient of $54,500 (95%CI: $43,600-$65,400). Additional postoperative complications occurred more frequently in patients with AKI and SS; each with an average cost increase of 8 to 9 times that of patients without AKI and SS. The most common and costly were ICU admission greater than 2 days (95%, $180,100 95% CI: $174,300, $186,000) and mechanical ventilation > 2 days (82%, $198,900 95% CI: $192.900, $205,000). Conclusions: Hospital costs of concurrent SS and AKI are higher than in any other subset of patients adjusting for inflation, patient demographics and clinical characteristics. AKI is a common complication in patients with SS and contributes to increased resource utilization and cost. Whether the use of treatment protocols for SS decreases occurrence of AKI and subsequently reduces the cost requires further investigation.

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Introduction: Postoperative acute kidney injury (AKI) and severe sepsis (SS) are both associated with a risk of short-term and long-term mortality. The effect of prolonged ICU hospitalization (admission to intensive care unit (ICU) ≥ 14 days) may modulate the effect of AKI on the long-term survival of patients with AKI. Methods: This is a retrospective cohort study of 2404 patients with SS and no history of prior chronic kidney disease identified from a cohort of 51,577 patients discharged after major surgery between 2000 and 2010 in an academic tertiary medical center. SS was identified by combining International Classification of Diseases, Ninth Revision, Clinical Modification codes for acute organ dysfunction and sepsis. AKI was defined by the RIFLE (Risk, Injury, Failure, Loss, and End-stage Kidney) classification, which requires at least a 50% increase in serum creatinine (sCr). Patient survival was determined through the National Social Security Death Index. Long-term survival was analyzed using a risk-adjusted Cox proportional hazards regression model. Results: A majority (82%) of SS patients had prolonged ICU hospitalization, while 9% were discharged prior to day 14 of ICU stay and 9% died during their ICU stay. One-year cumulative survival probability was significantly worse for SS patients with prolonged ICU hospitalization (0.60 vs. 0.86). In the risk-adjusted model survival was mediated by both prolonged ICU hospitalization and AKI, and was worse for patients with both conditions (adjusted hazard ratio AHR 4.35, 95% confidence interval CI 2.46 to 8.72). Both prolonged ICU hospitalization alone and AKI alone were associated with worse survival after SS, although only AKI reached statistical significance (prolonged ICU hospitalization AHR 2.04, 95%CI 0.95-4.64; AKI AHR 2.01, 95% CI 1.05-4.26). Conclusions: In a large single-center cohort of surgical patients with SS, AKI and prolonged ICU hospitalization have additive adverse effects on long-term survival.

Nitrotyrosine Level Was Associated with Mortality in Patients with Acute Kidney Injury

BackgroundTo examine the characteristics of oxidative stress in patients with acute kidney injury (AKI) and investigate the association between plasma nitrotyrosine levels and 90-day mortality in patients with AKI.Methodology/Principal Findings158 patients with hospital-acquired AKI were recruited to this prospective cohort study according to RIFLE (Risk, Injury, Failure, Lost or End Stage Kidney) criteria. Twelve critically ill patients without AKI and 15 age and gender-matched healthy subjects served as control. Plasma 3-nitrotyrosine was analyzed in relation to 90-day all cause mortality of patients with AKI. The patients with AKI were followed up for 90 days and grouped according to median plasma 3-nitrotyrosine concentrations. Highest 3-NT/Tyr was detected in patients with AKI compared with healthy subjects, and critically ill patients without AKI (ANOVA p<0.001). The 90-day survival curves of patients with high 3-NT/Tyr showed significant differences compared with the curves of individuals with low 3-NT/Tyr (p = 0.001 by log rank test). Multivariate analysis (Cox regression) revealed that 3-NT/Tyr (p = 0.025) was independently associated with mortality after adjustment for age, gender, sepsis and Acute Physiology and Chronic Health Evaluation (APACHE) II score.Conclusions/SignificanceThere is excess plasma protein oxidation in patients with AKI, as evidenced by increased nitrotyrosine content. 3-NT/Tyr level was associated with mortality of AKI patients independent of the severity of illness.

National Surgical Quality Improvement Program Underestimates the Risk Associated With Mild and Moderate Postoperative Acute Kidney Injury

In a single-center cohort of surgical patients, we assessed the association between postoperative change in serum creatinine and adverse outcomes and compared the American College of Surgeons National Surgical Quality Improvement Program's definition for acute kidney injury with consensus risk, injury, failure, loss, and end-stage kidney and Kidney Disease: Improving Global Outcomes definitions. Retrospective single-center cohort. Academic tertiary medical center. Twenty-seven thousand eight hundred forty-one adult patients with no previous history of chronic kidney disease undergoing major surgery. Risk, injury, failure, loss, and end-stage kidney defines acute kidney injury as change in serum creatinine greater than or equal to 50% while Kidney Disease: Improving Global Outcomes uses 0.3 mg/dL change from the reference serum creatinine. Since National Surgical Quality Improvement Program defines acute kidney injury as serum creatinine change greater than 2 mg/dL, it may underestimate the risk associated with less severe acute kidney injury. The optimal discrimination limits for both percent and absolute serum creatinine changes were calculated by maximizing sensitivity and specificity along the receiver operating characteristic curves for postoperative complications and mortality. Although prevalence of risk, injury, failure, loss, and end-stage kidney-acute kidney injury was 37%, only 7% of risk, injury, failure, loss, and end-stage kidney-acute kidney injury patients would be diagnosed with acute kidney injury using the National Surgical Quality Improvement Program definition. In multivariable logistic models, patients with risk, injury, failure, loss, and end-stage kidney or Kidney Disease: Improving Global Outcomes-acute kidney injury had a 10 times higher odds of dying compared to patients without acute kidney injury. The optimal discrimination limits for change in serum creatinine associated with adverse postoperative outcomes were as low as 0.2 mg/dL while the National Surgical Quality Improvement Program discrimination limit of 2.0 mg/dL had low sensitivity (0.05-0.28). Current American College of Surgeons National Surgical Quality Improvement Program definition underestimates the risk associated with mild and moderate acute kidney injury otherwise captured by the consensus risk, injury, failure, loss, and end-stage kidney and Kidney Disease: Improving Global Outcomes criteria.

A Review of Hemodialysis Vascular Access Devices

The number of clients with end-stage renal disease and acute kidney injury requiring kidney replacement therapy is at an all-time high. At the end of 2010, the number of persons in the United States with end-stage renal disease totaled 594,374. Because the majority of clients select hemodialysis, understanding best-practice techniques to prevent infection is paramount. The purpose of this article is to review best-practice recommendations for care of the 3 major vascular access devices used for hemodialysis, with a particular focus on infection prevention recommendations. Implications for infusion nurses are also discussed.

Fat-poor renal angiomyolipoma in a patient with an end-stage kidney

Angiomyolipoma in end-stage kidneys is very rare. The differentiation of an angiomyolipoma from a renal cell carcinoma is important because angiomyolipomas do not usually need to be surgically removed. The diagnosis of an angiomyolipoma is made by demonstrating bulky fat within a solid renal mass. When angiomyolipomas contain a large amount of internal fat, the diagnosis is not challenging. However, if the angiomyolipoma contains a small amount of fat, it can be challenging to detect on CT scanning. When a small amount of fat is suspected in a renal mass, an unenhanced CT examination with thin sections combined with a pixel analysis is the most sensitive test to confirm the presence of fat. A small number of angiomyolipomas do not contain macroscopic fat, and the imaging differentiation from a renal neoplasm is difficult. A 52-year-old woman with chronic renal failure was admitted to Oyokyo Kidney Research Institute Hirosaki Hospital for induction of hemodialysis. Screening computed tomography revealed an enhancing tumor without fat attenuation (size 3 × 2.5 cm) in the left kidney. Based on these findings, we diagnosed the patient with renal cell carcinoma and performed a radical left nephrectomy. However, histological examination of the tumor revealed the presence of angiomatous, myomatous, and lipomatous components. Furthermore, immunohistological examinations showed that the tumor cells were strongly positive for smooth muscle actin, desmin, and HMB-45. Based on these findings, we diagnosed fat-poor angiomyolipoma in a patient with end-stage kidneys. Diagnosing renal angiomyolipomas is challenging when the tumor contains a minimal amount of fat. It may be difficult to distinguish between fat-poor angiomyolipoma and renal cell carcinoma preoperatively based on cross-sectional imaging findings alone, especially in patients with end-stage kidneys.