Haemodialysis related renal cell carcinoma

Hla OO, Pemasari Upali TELISINGHE, Ghazala KAFEEL, Prathibha Parampalli SUBRHAMANYA, Sowmya Tatti RAJARAM     

Department of Pathology, RIPAS Hospital, Brunei Darussalam

ABSTRACT

Introduction: Development of renal cell carcinoma (RCC) is a life threatening complication of long-term haemodialysis. Studies have shown that approximately one third or more of patient on long-term haemodialysis of more than three years will developed acquired cystic kidney disease (ACKD), and 20-50% of patients with ACKD, particularly with complex cysts of Bosniak types IIF, III and IV, may eventually transform into RCC. This study look at the incidence of haemodialysis related RCC in Brunei Darussalam. Material and Methods: Cases of RCC registered in the Department of Pathology registry from January 2000 to December 2010 were identified and retrospectively reviewed. Results: A total number of 5,287 malignancies were reported during this period and 74 were RCC, giving an overall incidence of 1.4%. Out of these 74 cases, 6.75% (n=5) was found to be RCC transformed from ACKD associated with long-term haemodialysis. There was a male preponderance (4:1), four Malays men and one Chinese lady with a median age of 51 years (37-66) at diagnosis. The duration of haemodialysis dialysis prior to the development of RCC ranged from 4 to 16 years. The common presenting signs and symptoms were cystic mass in kidney 60% (n=3), haematuria and metastatic RCC in urinary bladder 20% (n=1), metastasis to the neck glands 20% (n=1). The right kidney was affected in four (80%) and one on the left (20%). Conclusion: Our study showed that ACKD associated RCC accounted for 6.8% of all RCC, and the duration to RCC development ranged from four to 16 years. There was a male preponderance. Radiological screening may need to be considered for patients at risk.

Keywords: Acquired cystic kidney disease, haemodialysis, neoplasm, renal cell carcinoma

Correspondence author: Hla OO. Department of Pathology, RIPAS Hospital, Bandar Seri Begawan BA1710 Brunei Darussalam

Tel: +673 2242424 Ext 6508

E mail: hlaoo39@yahoo.com

Brunei Int Med J. 2013; 9 (2): 93-96