鈴木 真¹, 児島 弘臣², 滝沢 謙治¹, 田村 信一¹, 東 澄典¹, 大淵 真男¹, 石川 昌澄¹, 片山 通夫¹, 越川 昭三², 甲斐 祥生³, 池内 隆夫³, 森川 文雄³, 佐々木 春明³

Shin SUZUKI¹, Hiroomi KOJIMA², Kenji TAKIZAWA¹, Shinichi TAMURA¹, Suminori HIGASHI¹, Masao OHBUCHI¹, Masazumi ISHIKAWA¹, Michio KATAYAMA¹, Shozo KOSHIKAWA², Yoshio KAI³, Takao IKEUCHI³, Fumio MORIKAWA³, Haruaki SASAKI³

¹昭和大学藤が丘病院放射線科, ²昭和大学藤が丘病院腎臓内科, ³昭和大学藤が丘病院泌尿器科

¹Department of Radiology Showa University Fuiigaoka Hospital, ²Department of Nephrology Showa University Fuiigaoka Hospital, ³Department of Urology Showa University Fuiigaoka Hospital

キーワード : US, CT, Kidney cyst, Kidney tumor, Hemodialysis

Because the kidneys of long-term hemodialysis patients frequently demonstrate multiple small acquired cysts and renal tumors on pathologic examination, more intense radiologic monitoring of these patients is recommended to detect renal malignancy.
We examined 60 chronically hemodialysed patients to assess the presence of acquired cystic disease of the kidney (ACDK) and renal tumor by using ultrasound (US) and computer assisted tomography (CT).
Since the ability of spatial resolution of US and CT are not enough te detect smaller cysts less than 5 mm, we interpreted that the patients whose each kidney have more than 4 cysts which are clearly demonstrated in these medical imagings may be equal to the category of ACDK.
The incidence of ACDK in these long-term hemodialysis patients (mean hemodialysis period was 7.5 years) was 38.3%, and the longer hemodialysis period correlated well to the higher incidence of ACDK.
There were two cases of renal cell carcinoma, these were finally confirmed by operation, in this prospectively analysed patients group.
In 1st case of renal cell carcinoma being associated with ACDK, 3 cm sized tumor in right kidney was clearly visualized as echogenic mass on US and solid mass on CT images, respectively. And in 2nd case of renal cell carcinoma being not associated with ACDK, US and CT images demonstrated 7 cm sized solid tumor which appeared to be developed in left atrophic kidney.
Although many authors stressed that ACDK should be considered to be premalignant kidney, renal cell carcinoma occuring in dialyzed patients may be appeared either with or without ACDK especially in the patients of older age group.
Therefore intense radiologic monitoring using US and CT should be required not only to the patients of ACDK but also to the patients having a abnormal sized kidney which are unsuitable to atrophic dialysed kidney.