Abstract

Introduction: The incidence of acquired renal cystic disease (ARCD) in end stage renal disease patients treated by long term hemodialysis is reported to be 30-95%. Patients with ARCD may present with hemorrhage of the cyst and retroperitoneal hematoma, and renal cell carcinoma develops in 1.5% of ARCD patients. Worldwide experience to date in combined pathology and radiology series of patients undergoing hemodialysis demonstrates that acquired cystic disease, ‘tumor’ (usually adenoma or oncocytoma) and renal carcinoma occur at respective rates of 47.1, 4.8 and 1.5 per cent. The aim of this study is to question the necessity of serial investigation of the native kidneys in hemodialysis and renal transplant patients (RTx).

Materials and Methods: Native kidneys of 19 patients on long term hemodialysis and 28 patients with RTx after long term hemodialysis were evaluated and followed serially by ultrasonography (US). In equivocal cases, computed tomography (CT) and/or magnetic resonans imaging (MRI) were added to evaluation.

Results: The mean age of the hemodialysis group was 34±12.8 (range: 17-60) years and the mean hemodialysis priod was 47.3±16.8 (range: 27-84) months. In this group, US revealed cysts in 62.5% of the patients of whom the cyst were bilateral in 70%. In one case (6.1%), a retroperitoneal hematoma was found. In 5 patients, CT and/or MRI were needed additionally.

Renal cell carcinoma was found in one patient (6.1%). The mean age of the RTx group was 33±10.7 (range: 14-55) years and the mean pretransplant hemodialysis period was 32±18.2 (range: 6-84) months. In this group, ARCD was diagnosed by US in 32% of the patients of whom the disease was bilateral in 80%. Additionally, CT and/or MRI were required in 4 patients of whom one (3.6%) was proved to be a renal carcinoma.

Conclusion: The incidence of ARCD is quite high in patients who received long term hemodialysis. Since patients with ARCD are usually young and asymptomatic, it might therefore be necessary to follow the disease by US for early detection of complications. CT and/or MRI are helpful diagnostic tools for detecting malignancy in suspected cases