Acquired cystic disease of the kidneys; a hazard of long-term intermittentmaintenance haemodialysis

SUMMARY In the period 1968-76, necropsies were carried out on 30 patients who had been treated by long-term intermittent maintenance haemodialysis. Fourteen of these patients developed bilateral cystic disease of the kidney. Clinical, pathological, and radiological investigation of these patients when they first presented did not reveal any evidence of renal cystic change. The main complications of this condition are haemorrhage and tumour formation. Six patients developed renal tumours, and in five cases these were multiple. The histological appearance of these neoplasms gave no indication as to whether they would behave in an aggressive manner. One patient died of metastatic carcinomatosis from a renal primary. The condition of acquired cystic disease of the kidney should be suspected if patients on maintenance haemodialysis suffer from recurrent haematuria or are found to have enlarging kidneys. End stage renal disease, and in particular chronic glomerulonephritis, is associated with small scarred contracted kidneys (Heptinstall, 1968; 1974). The advent of long-term intermittent haemodialysis has resulted in patients with this previously lethal condition living for years and in many instances receiving a renal allograft enabling them to return to a normal working life. An opportunity to examine the kidneys of such patients is provided not only at necropsy but also when bilateral nephrectomy is performed in order to control hypertension. Wereport here cystic transformation in the kidneys of these patients and point out the complications of this change. Clinical features During the period 1968-76, 236 patients were accepted for long-term intermittent haemodialysis. Fifty-one died and necropsies were performed on 30. Congenital adult polycystic disease of the kidneys was excluded from this study. Fourteen patients were found at necropsy to have extensive bilateral cystic disease of the kidneys. The brief clinical details of these patients are given in the Table. The mean age at death was 47-8 years and the mean length of time on maintenance haemodialysis was 3-4 years. Although renal biopsy had been performed in onl