慢性腎不全患者の固有腎に発生する多嚢胞性病変(Acquired cystic disease of kidneys,ACDK)にみられる腎細胞癌

Abstract

1)ACDKに合併する腎細胞癌は, 若年の男性で長期透析例に発生が多くみられる. 2)ACDKに合併する腎細胞癌の診断は, 超音波検査とCT scanを併用することによりほぼ100%診断可能と考える. 3)ACDKに合併する腎細胞癌は, 悪性度が低いと考えられ, 患側の腰部斜切開による腹膜外の単純腎摘除術で十分対処可能と考えられる. 4)若年の男性で3年以上の長期透析例では, 定期的な腎のスクリーニングが必要である

Since the first report in 1977 by Dunnill et al., a substantial number of articles have been written concerning the complications of acquired cystic disease of the kidneys (ACDK) and renal cell carcinoma developing in the native kidneys of patients undergoing long-term hemodialysis. The incidence has been reported to be 35% to 95% of ACDK in patients undergoing long-term hemodialysis. In addition, renal cell carcinoma has been described in 4% to 7% of the ACDK. The etiology of ACDK and renal cell carcinoma in the native kidneys of patients undergoing long-term hemodialysis remains unresolved. Because ACDK and renal cell carcinoma are usually asymptomatic, several reports described the use of imaging studies in the native kidneys of patients undergoing long-term hemodialysis and suggest a variety of management schemes to screen or monitor the status of the native kidneys. Ultrasonography is the most common screening study, but CT scan is more sensitive. Both studies are necessary to diagnose ACDK and renal cell carcinoma in the native kidneys of patients. We review our 10 cases and the Japanese literature with particular attention to the diagnosis and treatment of patients with ACDK and renal cell carcinoma. Our findings were similar to those reported by others. Patients receiving dialysis treatment for more than three years should have a baseline radiologic examination of the kidneys so that subsequent problems can be more easily identified and evaluated. The best surgical treatment for patients with ACDK and renal cell carcinoma is simple nephrectomy by flank incision in order to prevent surgical side effects, for example postoperative bleeding.