Renal cancer complicating acquired cystic kidney disease.

Acquired cystic kidney disease (ACKD) occurs in the setting of prolonged azotemia and is therefore common in dialysis patients. It is characterized by epithelial proliferation, and its major complication is the development of renal cancer. The incidence of renal cancer is significantly increased in ACKD patients and is probably increased overall in the ESRD population as well. Those ESRD patients with suspicious symptoms, prolonged predialysis azotemia, or a dialysis duration of longer than 3 yr, or those who are candidates for a renal transplant should be screened for ACKD. Sonography or computed tomographic scanning are useful as initial screening tools. However, although more expensive and requiring contrast administration, the contrast-enhanced computed tomographic scan is the definitive imaging procedure by which to initially evaluate a renal mass. A suspicious renal mass is a patient who is a surgical candidate is an indication for a radical nephrectomy.

Development of malignancy in the end-stage renal disease patient.

The evidence indicates an increased prevalence and likely also an increased incidence of both renal and extrarenal malignancy in ESRD patients. With the exception of nonHodgkin's lymphoma, these are the same solid tumors commonly found in the general population. Although the overall change in tumor frequency may be small, certain tumors such as prostate carcinoma, cutaneous melanoma, and uterine carcinoma are significantly increased in the setting of renal failure. Better detection secondary to closer medical surveillance of the dialysis population may contribute in part to the increased prevalence. The increased prevalence of renal cancer is unique because of its development as a complication of prolonged azotemia in the setting of ACKD. This calls for additional renal imaging such as contrast-enhanced CT scanning along with other established screening procedures.