Chapter

Acquired cysts and cancer of failing kidneys

Isao Ishikawa

in Cancer and the Kidney

Second edition

Published on behalf of Oxford University Press

Published in print November 2010 | ISBN: 9780199580194
Published online November 2012 | e-ISBN: 9780191753404 | DOI: http://dx.doi.org/10.1093/med/9780199580194.003.0011

Series: Oxford Clinical Nephrology Series

Acquired cysts and cancer of failing kidneys

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1 Acquired renal cysts develop in the failing contracted kidney and RCC develops in some patients thereafter. The incidence and severity of acquired renal cysts are both high in relatively young males, and in patients on long-term hemodialysis. Most acquired renal cysts regress following successful renal transplantation. Histology of ACDK demonstrates pre-cancerous changes, such as atypical renal cysts and renal adenomas. 2 The incidence of RCC in dialysis patients is higher than that in the general population, and 81% of RCC in dialysis patients develop as a complication of ACDK. 3 RCC complicated with acquired renal cysts develops mainly by the mechanism of cyst-atypical cyst-adenoma-RCC sequences, although this is genetically unproven. RCC with acquired renal cysts is often seen in comparatively young males with long-term hemodialysis, is surrounded by many acquired renal cysts, and does not bulge from the kidney outline. The diagnosis of such RCC is difficult because there is little enhancement by dynamic helical CT. 4 New histologies, ACD-associated RCC, and clear cell papillary RCC of end-stage kidneys which do not fit the classification of classic RCCs have been proposed and account for about 60% of ESRD patients. Moreover, pathogenesis of these tumors may differ from that of classic sporadic RCC. 5 Since RCC in dialysis patients shows a high incidence, is asymptomatic, and has a good post-operative prognosis, screening for RCC is recommended for selected dialysis patients. In particular, screening for RCC is necessary before renal transplantation. Screening for RCC should be based on the risks of age and gender, and on the general condition of the patient. In 15.4% of dialysis patients with RCC, RCC had metastasized by the time of our surveys. Some hemodialysis patients develop rapidly progressive RCC. Laparoscopic radical nephrectomy is preferred. Sorafenib or sunitinib is also beginning to be used in patients with progressive RCC.

Chapter.  7558 words.  Illustrated.

Subjects: Nephrology ; Medical Oncology

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