الفهرس Only 14 pages are availabe for public view
 |  | from | 161 |  |  |
| | | from | 161 | | |
Abstract
ACKD is one of complications of hemodialysis. acquired cystic renal disease must be distinguished from other acquired renal cystic diseases such as the simple renal cysts that develop with advancing age, and the cystic changes found with primary hyper¬aldosteronism that are probably related to hypokalemia. It also must be distinguished from hereditary autosomal-dominant poly¬cystic disease, and from rare causes of cystic kidneys such as tuberous sclerosis, Von-Hipple-Lindau disease, autosomal¬recessive polycystic disease, medullary cystic disease and medullary sponge kidney.Acquired cystic renal disease is not specifically related to any one of the causes of chronic renal failure, and may be commoner in males and in black patients. It also occurs in the kidneys of children on long-term dialysis at a frequency comparable to that seen in the adult patient population. While ACRD is often thought of as a complication found in hemodialysis patients, the incidence is similar in patients treated by long-term continuous ambulatory peritoneal dialysis (CAPD).Renal cell carcinoma in a patient with ACRD may be asymptomatic in as many as 86% of cases, although in many of these the tumor is small and may still be considered an adenoma. In those patients who develop symptoms, the commonest are due to bleeding into the tissue of the tumor, into the renal parenchyma with rapid swelling of the kidney, into the subcapsular or retroperitoneal space with flank pain, or into the pyelocalyceal system resulting in gross hematuria. In some cases, persistent hematuria may be the only symptom and the cancer may not be detectable by the usual imaging procedures.Life expectancy after transplantation has improved with advances in the discipline over recent decades so that it is now well more than double that of a patient on dialysis regardless of age. In 2004, the expected remaining lifetime of a US transplant recipient 50 to 54 yr of age, which was the average age of the patients with renal cell cancer in the report by Schwarz et al., was 17 yr. Cancer may soon be the leading cause of death late after transplantation. Despite the low prevalence of renal cell cancer in ESRD, the relatively benign course of the affected patients in the report by Schwarz et al., and the possibility of lesser cancer risk with newer immunosuppressive regimens, it is time to rethink the published guidelines and consider screening all kidney transplant candidates and recipients for ACKD and renal cell cancer.