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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 1997  |  Volume : 8  |  Issue : 1  |  Page : 8-10
Acquired Cystic Renal Disease in Patients Receiving Long-term Hemodialysis


1 Division of Nephrology, Department of Medicine, Najran General Hospital, Najran, Saudi Arabia
2 Department of Radiology, Najran General Hospital, Najran, Saudi Arabia

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   Abstract 

Thirty seven patients with End Stage Renal Disease (ESRD) on maintenance hemodialysis at our center were studied for prevalence of Acquired Cystic Renal Disease (ACRD). Eighteen (49%) patients had documented ACRD. The mean age was 50.4 years. The proportion of patients with ACRD rose with increasing duration of dialysis. In our study, ACRD was found in 71.4% of patients who had dialysis for more than four years and in 43.3% of patients who underwent dialysis for less than four years. All of our patients with ACRD remained asymptomatic except one who had flank pain and macro-hematuria. There was no clinical or ultrasonographic evidence of renal neoplasm in any of these patients.

Keywords: Acquired cystic renal disease, End stage renal disease, Hemodialysis, Neoplasm.

How to cite this article:
Kumar R, Mishra HK. Acquired Cystic Renal Disease in Patients Receiving Long-term Hemodialysis. Saudi J Kidney Dis Transpl 1997;8:8-10

How to cite this URL:
Kumar R, Mishra HK. Acquired Cystic Renal Disease in Patients Receiving Long-term Hemodialysis. Saudi J Kidney Dis Transpl [serial online] 1997 [cited 2020 Jun 4];8:8-10. Available from: http://www.sjkdt.org/text.asp?1997/8/1/8/39396

   Introduction Top


Acquired cystic renal disease was first described by Dunnil et al in 1997 [1] . It occurs in patients who receive long-term hemodialysis or continuous ambulatory peritoneal dialysis [2] . This disease entity has also been demonstrated in patients with mild chronic failure not yet requiring dialysis [3] . Also majority of patients remain asympto­matic, there is increased risk of development of neoplasms in these cysts. In this study we attempted to determine the prevalence of this disease and the risk factors for its development in hemodialysis patients.


   Materials and Methods Top


We received the medical records of 37 patients of ESRD undergoing hemodialysis at Najran General Hospital, Najran, Saudi Arabia during the period between October 1995 and March, 1996. the collected data included the causes of renal failure, duration of hemodialysis, and blood pressure. All these patients were selected on the basis of initial ultrasound reports at the start of dialysis therapy. Only patients with no cystic lesion in either kidney were included in the study.

All the patients were screened during the period of study for presence of cystic disease by ultrasound with Kontron, type sigma 44 HCVD, using 3.5 MHz sector transducer. Kidneys were visualized from parasagittal and posterior approach. Acquired cystic renal disease was diagnosed when bilateral multiple sonolucent areas with no internal echos were present.


   Results Top


Eighteen (49%) of the 37 patients were found to have acquired cystic renal disease. There were 10 (56%) males and 8 (44%) females with mean age of 50.4 years (range 16-85 years). The propable causes of ESRD in these patients, based on clinical criteria, included essential hypertension in 5 (27.7%), chronic pyelonephritis in 3 (16.6%), chronic glomerulonephritis in 3 (16.6%), nephro­lithiasis in 3 (16.6%) diabetic nephropathy in 2 (11.1%) and others in 2 (11.1%). The relation of ACRD to the underlying cause of ESRD is shown in [Table - 1].

The proportion of patients with ACRD rose with increasing duration of dialysis. Eighty percent of patients dialyzed for more than six years had cysts [Table - 2].

Hematocrit was not significantly raised in patients with ACRD (28.2 ± 3.7%) when com­pared to patients without cysts (26.4 ± 3.7%).

There was no recognizable clinical com­plication of these cysts with the exception of one patient who had acute flank pain and gross hematuria. Computed tomogram (CT) scan showed bleeding in a cyst and ruled out the presence of tumour. No features of a neoplasm could be detected in any of the study patients by ultrasonography.


   Discussion Top


Dunnil et al reported ACRD for the first time in 14 (46.6%) out of 30 long term dialysis patients in an autopsy study during 1977 [1] . Subsequently ACRD has been described in 262 cases out of 601 patients undergoing dialysis with an overall pre­valence of 43.6% [4] . These studies were performed using sonography. Computed tomography or autopsy. Prevalence of ACRD was found to be 49% in our study.

Prolonged duration of hemodialysis was implicated as an important risk factor for the development of ACRD [1],[2],[3],[4],[5],[6] . Our study results were comparable to the previous studies concerning this factor.

There seems to be no relationship between occurrence of ACRD and the underlying cause of ESRD [7] . But few reports had described the relatively low prevalence of ACRD in patients with diabetic nephro­pathy [3],[5] . Contrary to this, in. our study ACRD was observed in all the patients with diabetic nephropathy.

Acquired cystic renal disease is usually silent and is often discovered incidentally during radiologic procedures and/or when the kidneys are examined after nephrectomy or autopsy [1],[2],[3],[4] . However, bleeding into cysts [1],[8] , gross hematuria [8] , retroperitoneal hemorrhage [9],[10] and malignant transfor­mation [1],[11],[12] have been described as clinical complications of ACRD. In our study, one patient had flank pain with gross hematuria and CT scan revealed bleeding in the cyst without any tumour. He was managed conservatively and there was no recurrence of this problem.

Renal tumours have been found in 16.4% of patients with ACRD [4] . Although the majority of these tumours were small adenomas, some were malignant and few revealed systemic metastasis. In contrast, in our study, no features of neoplasm could be detected by ultrasonography in any of the patients. However, it must be admitted that ultrasound examination might have missed some tumours, as CT scan is the more reliable method for ruling out neoplastic changes in these renal cysts [13],[14] .

The exact cause of the cystic transfor­mation is not known but loss of functioning renal mass probably stimulates production of some renotropic factors which promote the development of ACRD [14],[15],[16] .

We conclude from our study that prevalence of ACRD may be high in patients with ESRD on long-term hemodialysis in Saudi Arabia. The proportion of patients with ACRD increase with increasing duration of dialysis.

 
   References Top

1.Dunmll MS, Millard PR, Oliver D. Acquired cystic disease of the kidneys: a hazard of long-term intermittent maintenance haemodialysis. J Clin Pathol 1977;30:868-77.  Back to cited text no. 1    
2.Ishikawa I. Uremic acquired cystic disease of kidney. Urology 1985;26:101-8.  Back to cited text no. 2  [PUBMED]  
3.Mickisch O, Bommer J, Bachmann S, Waldherr R, Mann JF, Ritz E. Multicystic transformation of kidneys in chronic renal failure. Nephron 1984;38:93-9.  Back to cited text no. 3  [PUBMED]  
4.Grantham JJ, Levine E. Acquired cystic disease: replacing one kidney disease with another. Kidney Int 1985;28:99-105.  Back to cited text no. 4  [PUBMED]  
5.Kidney health program: Annual report. Austin, Tex, Texas Dept of Health 1984.  Back to cited text no. 5    
6.Heinz-Peer-G; Schoder M, Rand T, Mayer G, Mostbeck GH. Prevalence of acquired cystic kidney disease and tumors in native kidneys of renal transplant recipients: a prospective US study. Radiology 1995; 195(3):667-71.  Back to cited text no. 6    
7.Sasagawa I, Terasawa Y, Imai K, Sekino H, Takahashi H. Acquired cystic disease of the kidney and renal carcinoma in haemodialysis patients: ultrasonographic evaluation. Br J Urol 1992;70(3):236-9.  Back to cited text no. 7    
8.Bommer J, Waldherr R, van Kaick G, Strauss L, Ritz E. Acquired renal cysts in uremic patients-in vivo demonstration by computed tomography. Clin Nephrol 1980;14:299-303.  Back to cited text no. 8  [PUBMED]  
9.Milutinovich J, Follette WC, Scribner BH. Spontaneous retroperitoneal bleeding in patients on chronic hemodialysis. Ann Intern Med 1977;86:189-92.  Back to cited text no. 9  [PUBMED]  
10.Shalhoub RJ. Retroperitoneal bleeding and hemodialysis (letter). Ann Intern Med 1977;86:829.  Back to cited text no. 10    
11.Hughson MD, Buchwald D, Fox M. Renal neoplasia and acquired cystic kidney disease in patients receiving long-term dialysis. Arch Pathol Lab Med 1986;110: 592-601.  Back to cited text no. 11  [PUBMED]  
12.Williams JC, Merguerian PA, Schned AR, Morrison PM. Acquired renal cystic disease and renal cell carcinoma in an allograft kidney. J Urol 1995;153(2):395-6.  Back to cited text no. 12    
13.Schillinger F. Acquired cystic kidney disease in renal insufficiency: a multicentre study. Group of Nephrologists of the East of France. Eur J Med 1993;2(8):457-60.  Back to cited text no. 13    
14.Truong LD, Krishnan B, Cao JT, Barrios R, Suki WN. Renal neoplasm in acquired cystic kidney disease. Am J Kidney Dis 1995;26(1):1-12.  Back to cited text no. 14    
15.Preuss HG. Compensatory renal growth symposium: an introduction. Kidney Int 1983;23:571-4.  Back to cited text no. 15    
16.Harris RH, Hise MK, Best CF. Renotrophic factors in urine. Kidney Int 1983;23:616-23.  Back to cited text no. 16  [PUBMED]  

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Correspondence Address:
Ramesh Kumar
Division of Nephrology, Department of Medicine, Najran General Hospital, Najran
Saudi Arabia
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PMID: 18417777

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    Materials and Me...
    Results
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