Evaluation of acquired cystic disease of the kidney in hemodialysis patients using ultrasonography

• Published in: Journal of Japanese Society for Dialysis Therapy Vol. 24; no. 5; pp. 631 - 640
• Main Authors: Nozuki, Mitsuru, Orikasa, Seiichi, Sekino, Hiroshi, Fujikura, Yoshihiro, Imai, Yutaka, Watanabe, Naoe, Suzuki, Tomio, Imai, Keiko, Terasawa, Yoshio, Ueda, Hitoshi
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Dialysis Therapy 1991
• Subjects: chronic renal failure; hemodialysis; renal carcinoma; renal cyst; ultrasonography
• ISSN: 0911-5889; 1884-6211
• DOI: 10.4009/jsdt1985.24.631

The development of cystic transformation of the kidney (ACDK) was investigated in 595 patients undergoing chronic hemodialysis. The number of renal cysts was determined by real-time sonography. Based on renal sonographic findings, 595 hemodialysis patients were classified into 4 groups according to the severity of cystic transformation (Grades O, I, II and III). Those classified into Grade O ACDK had no renal cysts. Those in Grade I ACDK had 5 or less, Grade II ACDK had more than 5 and fewer than 10, and Grade III ACDK had 10 or more. Cystic lesions increased with increasing duration of the hemodialysis treatment. Longitudinal dimension of the kidney, an index of renal volume, decreased gradually up to 4 years after the start of hemodialysis, reaching the minimum in the 4th to 6th year of hemodialysis, after which it increased gradually in male patients with chronic renal failure induced by chronic glomerulonephritis (CGN), while, in these patients, development of Grades II and III ACDK became more conspicuous with the increase in duration of hemodialysis; such an outcome was not observed in female patients or those with diabetic nephropathy. Grade III ACDK was detected in 55.4% of the male CGN patients, but in only 3.9% of female CGN patients, more than 10 years after the start of hemodialysis. Seventy percent of the latter were still Grade I. Serum creatinine and hematocrit levels in those with Grade III ACDK were significantly higher than those with lower Grade ACDK. These results indicate that the development and progress of ACDK depended considerably on gender differences. Androgen would be an important mediator of the development and progress of ACDK through its anabolic action which may provide for plasma creatinine level. The role of anabolic hromone in the development and progress of ACDK is also supported by the elevated hematocrit level in male subjects with Grade III. This is supported by the elevated hematocrit level in male subjects with Grade III ACDK. Renal cell carcinoma was confirmed in 10 of 595 patients (1.7%, 9 males and 1 female), a 7.5% incidence in those with Grade III ACDK, suggesting the clinical significance in grading of ACDK In screening for renal cell carcinoma.