Acquired cystic kidney disease (ACKD) may have been first described more than a century ago (1). Its recognition 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 studies 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 peritoneal 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. Kidney transplant recipients in the United States have been shown to carry a 15-fold risk for kidney cancer (which would include non–renal cell cancers as well) in the first 3 yr after transplantation when compared with the general US population and a 39% higher risk for developing kidney cancer in those years in comparison with transplant …
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