Unilateral renal cell carcinoma with coexistent renal disease: a rare cause of end-stage renal disease

Background. Renal cell carcinoma (RCC) is a disorder encompassing a wide sp ectrum of pathological renal lesions. Coexistence of unilateral RCC and ass ociated pathology in the contralateral kidney is an unusual and challenging therapeutic dilemma that can result in renal Failure. So far, data on unil ateral RCC with chronic renal failure necessitating renal replacement thera py have not been published. The aim of the present study was to evaluate th e incidence of end-stage renal disease (ESRD) from unilateral RCC, and to a ssess the associated pathology and possible pathogenic factors. Methods. In 1999, a survey of the 350 patients treated by chronic dialysis in Asturias, Spain, was carried out to identify and collect clinical inform ation on patients with primary unilateral RCC whilst on their renal replace ment programme. Results. Seven patients were identified as having ESRD and unilateral RCC, giving an incidence of 2% of patients treated by dialysis. There was a wide spectrum of associated disease and clinical presentation. All patients und erwent radical or partial nephrectomy and were free of recurrence 6-64 mont hs after surgery. Six patients were alive and free of malignancy recurrence for 6 30 months after the onset of haemodialysis. Conclusion. ESRD is rare in association with unilateral RCC, but does contr ibute to significant morbidity. However, the data presented here are encour aging and suggest that cancer-free survival with renal replacement therapy can be achieved in such patients.