ACQUIRED RENAL CYSTIC-DISEASE AND TUMOR-MARKERS IN CHRONIC-HEMODIALYSIS PATIENTS

Acquired renal cystic disease (ARCD) is a well documented complication of end-stage renal disease, and ii has been related to the duration o f dialysis therapy The association of this condition with renal cell a denoma or carcinoma has already been established. There have also been studies on the concentration of some tumor markers in hemodialysis (H D) patients, clinically free from neoplastic disease, where it was con cluded that some tumor markers could be elevated, despite the absence of malignant disease, suggesting their altered metabolism i.e. clearan ce by the hemodialysis membrane. We compared the pre-dialysis serum co ncentration of several tumor markers in three groups of chronic HD pat ients, all of whom had been on maintenance HD treatment for more than 5 years. Group I consisted of 16 patients without ARCD with a mean HD treatment duration of 97.06 +/- 28.25 months. Group 2 consisted of 32 patients with a mean HD treatment of 105.62 +/- 24.4 months who had AR CD with less than 10 renal cysts defected by ultrasonography. Group 3 consisted of 14 patients with a mean HD duration al 109.92 +/- 37.72 m onths, with ARCD and more than 10 renal cysts. Concentration of the fo llowing tumor markers was determined by EIA or ELISA methods. carcinoe mbryonic antigen (CEA), mucin-like carcinoma-associated antigen (MCA), neuron-specific enolase (NSE), carbohydrate antigen 19-9 (CA 19-9), p rostatic specific antigen (PSA), carbohydrate antigen 125 (CA 125), al pha fetoprotein (AFP), cytokeratin 19-fragments 21-1 (CYFRA 21-1). The concentration of all the tumor markers was comparable in all three pa tient groups, with no statistically significant difference between gro ups. The mean concentrations of MCA, PSA, CA 125 and AFP were within t he normal range. CEA and CYFRA 21-1 had mean values in the upper limit of their normal values, while NSE and CA 19-9 were increased by more than twofold in all three patient groups. We concluded that (i) tumor markers should be used with caution when diagnosing neoplastic disease s in chronic HD patients, because of their altered metabolism, and (ii ) that in the follow up of ARCD with possible neoplastic alteration, i maging techniques remain dominant diagnostic tools.