Tumours in End-Stage Kidney (original) (raw)

2008, Transplantation Proceedings

Objective. Patients with end-stage kidney disease (ESKD) show a greater risk for renal cell carcinoma (RCC), which tends to be multifocal and bilateral. The malignant potential is unclear. The question is whether to remove both kidneys in patients with a tumor on one side only diagnosed by computed tomography (CT). Materials and Methods. Kidney tumors were found in 14 patients with ESKD from January 2002 to December 2006. One was unfit for surgery. Thirteen patients underwent nephrectomy and 6 a bilateral procedure of whom only 2 had bilateral tumors on CT, 3 multiple tumors on the contralateral side, and 1 uncontrollable hypertension with tumors as an incidental finding. Tumors were found in all 19 specimens. Results. In 13 kidneys (68.4%), the tumors were multiple; in 6 (31.6%), solitary. The types of tumor were: 13 (68.4%) papillary RCCs (PRCC), 9 (47.4%) clear RCCs (CRCC), a combination of PRCC and CRCC in 4 (21.0%), and myxoid liposarcoma (with solitary PRCC contralaterally). The mean follow-up was short (19 Ϯ 15 months; maximum, 54 months). Only 1 patient died due to a tumor at 16 months after operation. Conclusions. There is a high risk for bilateral involvement. Patients who undergo unilateral nephrectomy must be regularly followed and contralateral nephrectomy carefully considered, mainly in transplanted patients on immunosuppression. Further studies are needed to give a definitive answer about the indications for surgery and the indications for contralateral nephrectomy as well. To date, prophylactic contralateral nephrectomy should not be a therapeutic standard. E ND-STAGE KIDNEY DISEASE (ESKD) is associated with cystic degenerative changes (acquired cystic kidney disease [ACKD]) and higher incidence of renal cell carcinoma (RCC). 1,2 The association of ESKD with ACKD and renal tumors was first recognized in 1977. 3 The incidence of ACKD is about 50% among dialysis patients but depends upon the duration of dialysis, the gender (3 times more frequent in men), and the diagnostic criteria. 4,5 RCCs in native end-stage kidneys are found in nearly 4% of patients, which contrasts with a 0.3% to 0.7% lifetime risk for developing RCCs in the general population. 4,6-8 Compared with sporadic RCCs, RCCs associated with ESKD and ACKD are characterized by young patients, predominantly male, are frequently multicentric and bilateral, and less aggressive. The posttransplantation risk for renal tumors persists. In transplanted patients, the RCC is usually quite aggressive, probably as a result of immunosuppression. 1,5,9 The high incidence of RCCs among ESKD, their multifocality and bilaterality generate the question whether contralateral nephrectomy is indicated for patients with ESKD and a unilateral kidney tumor diagnosed on a graphic examination (computed tomography [CT] or magnetic resonance imaging [MRI]). We have attempted to address this issue by reviewing our patients with RCCs in ESKD. The question of renal tumors is extremely important in the Czech Republic as it has the highest incidence of C64 in all the world: in 2003, 27.7/100,000 males and for females, 17.5. In the literature in 2006, tumors in ESKD aroused the interest of urologists, nephrologists, and pathologists. 10-14 MATERIALS AND METHODS At our institution, kidney tumors were found in 14 patients with ESKD from January 2002 to December 2006 (Table 1). Before 2002, we were not aware of these cases. We must mention that From the Departments of Urology (M.H.