By Isao Ishikawa

I were eager about the therapy of continual renal insuf? ciency for forty years, starting with peritoneal dialysis instantly after commencement from scientific tuition in 1965, then with hemodialysis in 1967 after I ? rst skilled it in Kanazawa, and with renal transplantation given that 1972, whilst i used to be learning within the usa. in this interval, the variety of dialysis sufferers has endured to extend quickly to the current ? gure of 257 765 (at the top of 2005), and with superb raises within the survival price. besides the fact that, new and unforeseen pathological stipulations have additionally seemed as issues of long term dialysis. this kind of includes polycystic alterations and their malignant transformation in diseased kidneys. due to the fact i've got studied those polycystic alterations and their malignant transformation for a few years, i made a decision to collect the result of my paintings in a ebook. Such stipulations of diseased kidneys pose critical difficulties, fairly in Japan, the place renal transplantation is played very every now and then in comparison with different nations, and plenty of sufferers are controlled through dialysis over an extended period.

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Additional info for Acquired Cystic Disease of the Kidney and Renal Cell Carcinoma: Complications of Long-Term Dialysis

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Renal cell carcinoma occurred more frequently within 1 year or between 5 and 15 years after the initiation of dialysis. The incidence of renal cell carcinoma increased with the duration of dialysis (Fig. 44). 1% [63]. In other 36 Acquired Cystic Disease of the Kidney and Renal Cell Carcinoma Fig. 44. Comparison of the annual incidence of renal cell carcinoma per 100 000 dialysis patients according to the duration of dialysis Table 10. 000 NS NS NS words, the duration of dialysis was 10 years or longer in about half the dialysis patients with renal cell carcinoma.

It had increased by 11 years during the 20 years of the surveys (Table 9). 1 years during the same period (Fig. 41). The mean ages of both the renal cell carcinoma patients and all the Fig. 40. Age distribution of renal cell carcinoma patients Fig. 41. Annual changes in the mean age of dialysis patients with and without renal cell carcinoma 34 Acquired Cystic Disease of the Kidney and Renal Cell Carcinoma Table 9. 12) a, Questionnaire year; b, Mean ± SD Fig. 42. Comparison of the incidence of renal cell carcinoma per 100 000 people between the general population and dialysis patients according to sex and age dialysis patients increased, probably because the age at the initiation of dialysis was gradually increasing, while renal cell carcinoma occurred more frequently in patients who had received dialysis for a long period from a relatively young age, and because renal cell carcinoma occurred at relatively young ages in dialysis patients.

A mass with an isodensity which is the same as that of renal parenchyma should be suspected to be a renal cell carcinoma. If the contrast enhancement of a mass is more than 10–20 HU by an enhanced helical CT scan, then it is a renal cell carcinoma 3. A large renal cell carcinoma often shows calcifications in the center or in the peripheral area, and there is also an irregular margin and inhomogeneous enhancement in the tumor 4. The image of a CT scan is not operator-dependent, and therefore it can easily be compared with the previous CT scan 5.

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