長期透析患者にみられる多嚢胞化萎縮腎と腎癌合併に関する臨床的検討

Abstract

透析中の患者167例をACDKの有無に従い2群に分類し, 各種検査成績を比較した.胃癌が疑われた12例とACDKの自然破裂により後腹膜腔に大出血をきたした1例の計13例に腎摘を施行し, 病理学的検討を行った.ACDKを認めた症例は63例, 平均透析期間は10.3年であり, ACDKを認めない群の平均透析期間5.0年との間に有意差が認められた.特に, 10年以上の症例では64.6%にACDKがみられた.ACDK群ではHt値, Hb値が有意に高かった.腎癌が疑われた12例中8例に組織学上腎細胞癌が, 1例に腺腫が認められた.後腹膜腔への出血をきたした症例に嚢胞上皮の過形成がみられた.8例の腎癌症例中5例にACDKが, 2例に組織学上嚢胞が認められ, うち1例はCAPD症例であり, また1例は両側腎癌症例であった.摘出腎に腎細胞癌以外の変化, すなわち嚢胞上皮に過形成あるいは腺腫が認められた症例は8例中5例であり, いずれも透析歴7.5年以上の症例であった.腎癌症例の発見時平均年齢は44.7歳で, 無症状患者の定期的スクリーニングによって発見された

Long-term dialysis patients frequently develop acquired cystic disease of the kidneys (ACDK). One hundred and sixty-seven dialysis patients were classified into two groups according to the presence or absence of ACDK, and the two groups were compared with regard to the dialysis period, laboratory findings, and so forth. Among the 167 dialysis patients, 37.7% showed ACDK and had an average dialysis duration of 10.3 years, which was significantly longer than the 5.0 years for patients without ACDK. The proportion of patients with ACDK rose with increasing duration of dialysis; 64.6% of the patients on dialysis for more than 10 years had ACDK. The values of hemoglobin and hematocrit of patients with ACDK were significantly higher than those without ACDK. Of 12 dialysis patients who were operated upon because of suspected renal tumor, pathological examination confirmed renal cell carcinoma in 8 and adenoma in one. One of these patients had been treated with chronic ambulatory peritoneal dialysis, and another had bilateral renal tumor. Among the 8 patients with renal cell carcinoma, ACDK was detected in 5 by means of CT and ultrasound tomography, and cystic changes were observed in two on light microscopic examination of the resected kidneys. Pathological examination of the non-tumorous renal tissues revealed hyperplastic or adenomatous changes in the cyst epithelium in 5 patients undergoing dialysis for more than 7.5 years. These changes were thought to be pre-neoplastic. The high incidence of ACDK and the development of renal tumors in long-term dialysis patients indicates the necessity of intensive monitoring.