Acquired cystic disease of the kidney: an indication for renal transplantation?

Risk of Renal Cell Carcinoma Among Kidney Transplant Recipients in the United States

Renal cell carcinoma (RCC) is a common malignancy following kidney transplantation. We describe RCC risk and examine RCC risk factors among US kidney recipients (1987-2010). The Transplant Cancer Match Study links the US transplant registry with 15 cancer registries. Standardized incidence ratios (SIRs) were used to compare RCC risk (overall and for clear cell [ccRCC] and papillary subtypes) to the general population. Associations with risk factors were assessed using Cox models. We identified 683 RCCs among 116 208 kidney recipients. RCC risk was substantially elevated compared with the general population (SIR 5.68, 95% confidence interval 5.27-6.13), especially for papillary RCC (SIR 13.3 versus 3.98 for ccRCC). Among kidney recipients, RCC risk was significantly elevated for blacks compared to whites (hazard ratio [HR] 1.50) and lower in females than males (HR 0.56). RCC risk increased with prolonged dialysis preceding transplantation (p-trend < 0.0001). Risk was variably associated for RCC subtypes with some medical conditions that were indications for transplantation: ccRCC risk was reduced with polycystic kidney disease (HR 0.54), and papillary RCC was increased with hypertensive nephrosclerosis (HR 2.02) and vascular diseases (HR 1.86). In conclusion, kidney recipients experience substantially elevated risk of RCC, especially for papillary RCC, and multiple factors contribute to these cancers.

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

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Acquired cystic disease of kidney associated with renal cell carcinoma in chronic dialysis patients

We describe 2 cases of acquired cystic disease of the kidney (ACDK) associated with renal cell carcinoma in patients treated with long-term hemodialysis. Both patients have had dialysis for five and eight years, respectively. Renal cell carcinomas of these patients are small, averaging 2 cm in diameter. They are clear cell type. Atypical epithelial hyperplasia arising from cystic areas can be seen intermingling with carcinoma. This confirms that atypical epithelial hyperplasia is a precursor of renal cell carcinoma. Although the incidence of renal cell carcinoma arising in ACDK is on the rise, the issue of how to manage patients with ACDK remained unsettled and required further study.

Acquired cystic disease of the kidney: ultrasound as the primary screening procedure

Patients with end-stage renal disease on long term dialysis may develop de novo renal cystic disease. We used ultrasound as a primary screening procedure for renal cysts in 71 patients. In seven patients (10%) the native kidneys could not be identified. In 35 patients renal cysts were identified indicating a prevalence of acquired renal cystic disease of 49%.

Severity of acquired renal cysts in native kidneys and renal allograft with long-standing poor function

To identify factors related to the development of uremic acquired cystic disease of the kidney, native and grafted kidneys were examined in four men and three women after kidney transplantation. The incidence and severity of cystic transformation of native kidneys and grafts were compared by plain computed tomographic scans. In a uremic environment (serum creatinine level of greater than or equal to 265 mumol/L [3 mg/dL] for an average of 5.0 years; range, 2.8 to 8.2 years), acquired renal cysts were formed in both the native kidneys and the graft in three of the male and one of the female patients. Cysts were extensive in the native kidneys but relatively infrequent in the grafts in three of the men. One male subject was found to have acquired cysts only in the native kidney. Acquired renal cysts developed even in grafts undergoing chronic rejection, and increased numbers were found in native kidneys that were in uremic conditions for long periods, both before and after renal transplantation. These results suggest that the duration of uremia is the most important factor in the development of acquired renal cysts.