NDT Advance Access originally published online on August 17, 2004
Nephrology Dialysis Transplantation 2004 19(11):2789-2796; doi:10.1093/ndt/gfh458
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Nephrol Dial Transplant Vol. 19 No. 11 © ERA-EDTA 2004; all rights reserved
Original Article
Renal cell carcinoma co-existent with other renal disease: clinico-pathological features in pre-dialysis patients and those receiving dialysis or renal transplantation
Services of 1 Nephrology and 2 Pathology, Hospital Universitario La Paz, Madrid, 3 Service of Nephrology, Hospital Aránzazu, San Sebastián, 4 Service of Nephrology, Hospital Dr Peset, Valencia, 5 Service of Pathology, Hospital Central de Asturias, Oviedo and 6 Section of Nephrology, Hospital General La Mancha Centro, Alcázar de San Juan, Spain
Correspondence and offprint requests to: Dr R. Peces, Sección de Nefrología, Hospital General La Mancha Centro, Avenida de la Constitución, 3, 13600 Alcázar de San Juan, Ciudad Real, Spain. Email: cpeces{at}varnet.com
Background. Patients on chronic dialysis are prone to developing acquired cystic kidney disease (ACKD), which may lead to the development of renal cell carcinoma (RCC). The risk factors for the development of RCC so far have not been determined in pre-dialysis patients with co-existent renal disease. The aim of this study was to evaluate the clinico-pathological features of RCC in pre-dialysis patients with associated renal diseases or in those undergoing chronic dialysis and renal transplantation.
Methods. We studied 32 kidneys from 31 patients with RCC and associated renal diseases. Of those, 18 kidneys were from 17 patients not on renal replacement therapy (RRT) when diagnosed with RCC; 14 patients received dialysis or dialysis followed by renal transplantation. Several clinico-pathological features were analysed and compared between the two groups.
Results. Overall, there was a preponderance of males (75%); nephrosclerosis was the predominant co-existent disease (31%). The median intervals from renal disease to RCC in the dialysis and transplanted groups were significantly longer than in the pre-dialysis group (15.8±1.1 vs 2.4±0.7 years, P<0.0001). In contrast to pre-dialysis RCC, the dialysis and transplant RCC groups had greater frequency of ACKD (100 vs 28%, P<0.0001), papillary type RCC (43 vs 11%, P<0.05) and multifocal tumours (43 vs 5%, P<0.05). At the end of the study, 71% of dialysis and transplanted patients and 72% of pre-dialysis patients were alive.
Conclusions. ACKD develops in dialysis patients, as it does in those with renal disease prior to RRT. The duration of renal disease, rather than the dialysis procedure itself, appears to be the main determinant of ACKD and RCC. The RCC occurring in patients with ACKD and prolonged RRT is more frequently of the papillary type and multifocal than the RCC occurring in patients with no or few acquired cysts and a short history of renal disease. Long-term outcomes did not differ between the two groups.
Keywords: acquired cystic kidney disease; haemodialysis; nephrectomy; pre-dialysis; renal cell carcinoma; renal transplantation
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