Development of adenocarcinoma and acquired cystic disease of the kidney in hemodialysis patients.

Ninety-six hemodialysis patients were examined using computed tomography (CT) scan. Multiple cysts were found in 43.5% of those on hemodialysis for less than 3 years and in 79.3% of those who had been on dialysis for more than 3 years. Four patients had adenocarcinoma of the kidney; all 4 were in their 3rd and 4th decade and had been on hemodialysis for more than 5 years. Histologically, renal cell carcinomas were clear cell, or clear and granular cell carcinomas. All cancer patients had acquired cysts, intracystic epithelial hyperplasia (atypical cysts) and cysts or solid adenoma in the same kidney. Such findings are similar to those of experimental cancer of the kidney with respect to multifocal and bilateral lesions. Of the 1,103 total reported dialysis patients in Japan and abroad, 47.1% had acquired cystic disease and 1.5% renal cell cancer. In a nationwide survey, a total of 119 patients (96 males and 23 females) with adenocarcinomas were found. Their mean age was 49.5 +/- 12.1 years. The mean duration of dialysis was 70.8 +/- 44.4 months. Twenty-five of them had metastases. Since the total number of hemodialysis patients in Japan is 66,310 (December, 1985), many adenocarcinomas may not have been discovered. Acquired cystic disease regresses rapidly after successful renal transplantation. This lends credence to the uremic metabolite accumulation hypothesis to explain the development of acquired cysts and tumors of the kidney in dialysis patients. In conclusion, renal cell carcinoma in dialysis patients is closely related to the acquired cystic disease of the kidney. The frequency of renal cell cancer in long-term dialysis patients is increasing because of the higher incidence of acquired cysts with longer dialysis administration.