Editorial Acquired Cystic Kidney Disease and Renal Cell Cancer after Transplantation: Time to Rethink Screening?

A cquired cystic kidney disease (ACKD) may have beenfirst described more than a century ago (1). Its recog-nition as a disease of consequence in patients who undergo long-term maintenance hemodialysis was in the 1970s (2). In the ensuing three decades, repeated cross-sectional stud-ies have corroborated early findings that this disease affects one third or more of long-term (3 yr) hemodialysis patients and that approximately 20 % of those with ACKD will have renal cell carcinoma, representing a prevalence of approximately 5% (3). Age, male gender, and duration of dialysis are primary risk factors. It may occur less frequently in those who are on peri-toneal dialysis and may regress after transplantation (4). Its pathogenesis is not understood but may relate to the activation of proto-oncogenes, which may also be responsible for the subsequent development of renal cell carcinoma (5). Transplantation carries risk for cancer, more so as the years of exposure to the immunosuppressive agents accrue. Kidne