Figure

Screening for acquired cystic kidney disease (ACKD) and renal neoplasms in patients receiving renal replacement therapy (RRT). The major clinical concern with ACKD is the risk of renal cell carcinoma, often the tubulopapillary type, associated with this disorder: the incidence is 50-times greater than in the general population. Moreover, ACKD-associated renal carcinoma is more often bilateral and multicentric; however, only a minority of them evolve into invasive carcinomas or cause metastases [5]. There is no doubt that imaging should be performed when a dialysis patient has symptoms such as flank pain and hematuria, the question of periodic screening for ACKD and neoplasms in asymptomatic dialysis patients is still being debated. Using decision analysis incorporating morbidity and mortality associated with nephrectomy in dialysis patients, Sarasin and coworkers [6] showed that only the youngest patients at risk for ACKD benefit from periodic screening. On the basis of this analysis, it has been proposed that screening be restricted to patients younger than 55 years, who have been on dialysis at least 3 years and are in good general condition. Recognized risk factors for renal cell carcinoma in ACKD are male gender, uremia of long standing, large kidneys, and analgesic nephropathy.

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