Brifi,phJournal of Urology (1992), 70, 2 3 6 2 3 9 01992 British Journal of Urology
Acquired Cystic Disease of the Kidney and Renal Carcinoma in Haemodialysis Patients: Ultrasonographic Evaluation I. SASAGAWA, Y. TERASAWA, K. IMAI, H. SEKINO and H. TAKAHASHI Kidney Centre and Department of Internal Medicine, Shakai- Hoken Hospital; Department of Internal Medicine, Kohjinkai Hospital, Sendai, Japan
Summary-Ultrasonography was performed in 66 1 dialysis patients and acquired cystic disease of the kidney was found in 156 (125 men and 3 1 women). A higher incidence of cystic disease was found in males. There was no significant difference between the patients with and those without acquired cystic disease in terms of average age, but the duration of haemodialysis in those with acquired cystic disease was significantly longer. There was an increased incidence of cystic disease in patients with glomerulonephritis and the duration of haemodialysis in these patients was significantly longer. This suggests that the increased incidence of acquired cystic disease of the kidneys in the patients with glomerulonephritis is simply related to the longer duration of treatment. Twelve patients with renal carcinoma were found in this study. The average age at diagnosis of renal carcinoma was not significantly different between the patients with and those without acquired cystic disease, but the duration of dialysis was significantly longer in renal carcinoma patients with acquired cystic disease. The incidence of renal carcinoma in dialysis patients with acquired cystic disease was 3.85% and in those without it was 1.19%. These rates are considerably higher than those found in the general population and indicate that the risk of renal carcinoma is higher in dialysis patients both with and without acquired cystic disease
Since acquired cystic disease of the kidney (ACDK) kidneys of haemodialysis patients by means of was first defined by Dunnill et al. (1977), a ultrasononography, and we discuss the prevalence substantial number of studies have been carried out of acquired cystic disease and renal carcinoma in on cystic changes in the kidneys of haemodialysis dialysis patients. patients (Ishikawaetal., 1980; Kutcheretal., 1983; Narashimhan et al., 1986). Acquired cystic disease Patients and Methods of the kidney is now well recognised and its relationship with renal carcinoma has been empha- The study group comprised 661 patients with endsised by Ishikawa and Shinoda (1983) and Basile et stage renal disease of various causes. They included al. (1988). However, most patients with this 393 males (59.5%) and 268 females (40.5%) with an condition have no clinical symptoms. Periodic age range of 15 to 83 years (median 54). All patients examination of the kidneys of haemodialysis pa- had been treated with haemodialysis for 1 to 225 tients is necessary for the early detection of renal months (median 75). The mean duration of haemocarcinoma and the efficacy of ultrasonography in dialysis in males and females was 79 months and this respect has been reported by Terasawa et al. 76 months respectively. Patients with polycystic (1990). In the present study, we examined the kidneys and renal tuberculosis were excluded from the study. Patients were examined with the Toshiba SSAAccepted for publication 30 August 1991 90A ultrasound machine using either a linear type 236
237
ACQUIRED CYSTIC DISEASE AND RENAL CARCINOMA IN HAEMODIALYSIS PATIENTS
3.5 MHz probe, a sector type 3.75 MHz probe, or a convex type 3.75 MHz probe. Scans were performed in cross-section, longitudinal, coronal and, if necessary, oblique planes from anterior and posterior regions. Acquired cystic disease of the kidney was defined as the presence of a number of cysts in each kidney.
Table 3 Duration of Haemodialysis in Patients with and without Glomerulonephritis Cause of renal failure
ACDK(-)
~
Glomerulonephritis Non-glomerulonephritis
Results
ACDK(+)
n = 123 135 45*t months n=33 107 f56t
+
n = 296 72 2 52* months n = 209 43+43
___
As shown in Table 1 , acquired cystic disease of the kidney was found in 156 of the 661 dialysis patients (23.6%). The commonest cause of renal failure in patients with ACDK was glomerulonephritis (78.9%). In patients without ACDK, the 2 main causes were glomerulonephritis (58.6%) and diabetes mellitus (17.4%) (Table 2). There was an increased incidence of cystic disease in patients with glomerulonephritis compared with the other groups (P
Acquired Cystic Disease of the Kidney and Renal Carcinoma in Haemodialysis Patients: Ultrasonographic Evaluation I. SASAGAWA, Y. TERASAWA, K. IMAI, H. SEKINO and H. TAKAHASHI Kidney Centre and Department of Internal Medicine, Shakai- Hoken Hospital; Department of Internal Medicine, Kohjinkai Hospital, Sendai, Japan
Summary-Ultrasonography was performed in 66 1 dialysis patients and acquired cystic disease of the kidney was found in 156 (125 men and 3 1 women). A higher incidence of cystic disease was found in males. There was no significant difference between the patients with and those without acquired cystic disease in terms of average age, but the duration of haemodialysis in those with acquired cystic disease was significantly longer. There was an increased incidence of cystic disease in patients with glomerulonephritis and the duration of haemodialysis in these patients was significantly longer. This suggests that the increased incidence of acquired cystic disease of the kidneys in the patients with glomerulonephritis is simply related to the longer duration of treatment. Twelve patients with renal carcinoma were found in this study. The average age at diagnosis of renal carcinoma was not significantly different between the patients with and those without acquired cystic disease, but the duration of dialysis was significantly longer in renal carcinoma patients with acquired cystic disease. The incidence of renal carcinoma in dialysis patients with acquired cystic disease was 3.85% and in those without it was 1.19%. These rates are considerably higher than those found in the general population and indicate that the risk of renal carcinoma is higher in dialysis patients both with and without acquired cystic disease
Since acquired cystic disease of the kidney (ACDK) kidneys of haemodialysis patients by means of was first defined by Dunnill et al. (1977), a ultrasononography, and we discuss the prevalence substantial number of studies have been carried out of acquired cystic disease and renal carcinoma in on cystic changes in the kidneys of haemodialysis dialysis patients. patients (Ishikawaetal., 1980; Kutcheretal., 1983; Narashimhan et al., 1986). Acquired cystic disease Patients and Methods of the kidney is now well recognised and its relationship with renal carcinoma has been empha- The study group comprised 661 patients with endsised by Ishikawa and Shinoda (1983) and Basile et stage renal disease of various causes. They included al. (1988). However, most patients with this 393 males (59.5%) and 268 females (40.5%) with an condition have no clinical symptoms. Periodic age range of 15 to 83 years (median 54). All patients examination of the kidneys of haemodialysis pa- had been treated with haemodialysis for 1 to 225 tients is necessary for the early detection of renal months (median 75). The mean duration of haemocarcinoma and the efficacy of ultrasonography in dialysis in males and females was 79 months and this respect has been reported by Terasawa et al. 76 months respectively. Patients with polycystic (1990). In the present study, we examined the kidneys and renal tuberculosis were excluded from the study. Patients were examined with the Toshiba SSAAccepted for publication 30 August 1991 90A ultrasound machine using either a linear type 236
237
ACQUIRED CYSTIC DISEASE AND RENAL CARCINOMA IN HAEMODIALYSIS PATIENTS
3.5 MHz probe, a sector type 3.75 MHz probe, or a convex type 3.75 MHz probe. Scans were performed in cross-section, longitudinal, coronal and, if necessary, oblique planes from anterior and posterior regions. Acquired cystic disease of the kidney was defined as the presence of a number of cysts in each kidney.
Table 3 Duration of Haemodialysis in Patients with and without Glomerulonephritis Cause of renal failure
ACDK(-)
~
Glomerulonephritis Non-glomerulonephritis
Results
ACDK(+)
n = 123 135 45*t months n=33 107 f56t
+
n = 296 72 2 52* months n = 209 43+43
___
As shown in Table 1 , acquired cystic disease of the kidney was found in 156 of the 661 dialysis patients (23.6%). The commonest cause of renal failure in patients with ACDK was glomerulonephritis (78.9%). In patients without ACDK, the 2 main causes were glomerulonephritis (58.6%) and diabetes mellitus (17.4%) (Table 2). There was an increased incidence of cystic disease in patients with glomerulonephritis compared with the other groups (P
