RENAL-CANCER COMPLICATING ACQUIRED CYSTIC KIDNEY-DISEASE

Acquired cystic kidney disease (ACKD) occurs in the setting of prolong ed azotemia and is therefore common in dialysis patients. It is charac terized by epithelial proliferation, and its major complication is the development of renal cancer. The incidence of renal cancer is signifi cantly increased in ACKD patients and is probably increased overall in the ESRD population as well. Those ESRD patients with suspicious symp toms, 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 an d requiring contrast administration, the contrast-enhanced computed to mographic scan is the definitive imaging procedure by which to initial ly evaluate a renal mass. A suspicious renal mass is a patient who is a surgical candidate is an indication for a radical nephrectomy.