Abstract: SA-PO971

Hematuria in a Chronic Hemodialysis Patient

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Konkesa, Anuradha, Rutgers, Morrisplains, New Jersey, United States
  • Thiruvarudsothy, Srikanth, Rutgers NJMS, Belleville, New Jersey, United States
  • Sharma, Neeraj, Rutgers University, Bloomfield, New Jersey, United States
  • Jeyarajasingam, Aravindan V., None, Swedesboro, New Jersey, United States
  • Munugoti, Sushma, Rutgers UNIVERSITY, Montclair, New Jersey, United States
  • Reddi, Alluru S., Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Piracha, Farah, Rutgers NJ Medical School, Staten Island, New York, United States
Background

Spontaneous gross hematuria in a chronic hemodialysis patient is an
uncommon finding which can be a consequence of renal cyst rupture, renal cell
carcinoma, angiomyolipoma, stones, or vascular diseases. We recently treated a
patient on chronic hemodialysis for spontaneous gross hematuria who was found to
have renal cysts and renal cell carcinoma.

Methods

A 47-year-old African American man with past medical history
of AIDS, hypertension, and ESRD on HD due to HIVAN since 2002 was evaluated
for gross hematuria (1 to 2 ml). Hematuria was not associated with flank pain,
weight loss, dysuria, or trauma. A CT scan of the abdomen and Pelvis with
contrast showed a 6.3x6.2x5.1 cm mass in the mid to upper pole of right Kidney.
There were bilateral renal cysts and both kidneys were atrophic. He underwent a
right laparoscopic nephrectomy. Histology revealed clear cell renal carcinoma.

Conclusion

Acquired cystic kidney disease (ACKD) is recognized as a disease of
consequence affecting patients on long-term hemodialysis (≥3 years), and the
prevalence of ACKD increases linearly with duration of dialysis. Approximately 1-
4% of patients with ACKD develop renal cell carcinoma (RCC), and the
development of cysts and their degeneration into carcinoma is poorly understood.
The range of patients affected by ACKD-RCC is very narrow. Compared to the
general population, the risk of developing RCC in ACKD is increased by more
than 100-fold. In general, RCC associated with ACKD is considered to be less
aggressive than sporadically occurring RCC. A CT scan should be performed to
rule out other causes of spontaneous renal rupture. Recommendation to screen
patients with ESRD for ACKD and renal cell cancer has not been uniform because
of their limited life expectancy; however we believe screening will be valuable for
patients in good general health with a good life expectancy.