Kreisel-Büstgens C, Büstgens L, Graben N
Zentrum für Innere Medizin des Universitätsklinikums, Essen.
Med Klin (Munich). 1990 Dec 15;85(12):683-9.
Kidneys of patients with advanced renal insufficiency undergo polycystic transformation, described as acquired cystic degeneration (ACD). In 118 chronic dialysis patients clinical data were compared with sonographic findings of their 221 cirrhotic kidneys: 74 (63%) patients showed distinctly discernible renal cysts: 19 patients hat one single cyst, nine patients had two to eight cysts, 46 patients had more than eight cysts. Accordingly 39% of patients had ACD. Cystic transformation was of the same degree on both sides and in a few cases so marked that a formal discrimination to congenital cystic disease seemed impossible. Cystic degeneration was not influenced by patient's age, sex or underlying renal disease, but was dependent on the duration of both, renal disease and dialysis treatment. After eight years 71% of dialysis patients had ACD. In coincidence with cystic transformation the size of the kidneys apparently normalized and Hb-concentration rose from 8 to 10 g/dl. Complications were seen in six patients: two severe retroperitoneal bleedings and four hypernephroma were observed. The etiology of cystic transformation and its possible role as precancerosis are discussed.
晚期肾功能不全患者的肾脏会发生多囊性转变,即所谓的获得性囊性变(ACD)。对118例慢性透析患者的临床资料与其221个硬化肾脏的超声检查结果进行了比较:74例(63%)患者显示出明显可辨的肾囊肿:19例患者有单个囊肿,9例患者有2至8个囊肿,46例患者有8个以上囊肿。因此,39%的患者患有ACD。双侧的囊性转变程度相同,在少数情况下非常明显,以至于似乎无法与先天性囊性疾病进行正式区分。囊性变不受患者年龄、性别或潜在肾脏疾病的影响,但取决于肾脏疾病和透析治疗的持续时间。8年后,71%的透析患者患有ACD。与囊性转变同时,肾脏大小明显恢复正常,血红蛋白浓度从8克/分升降至10克/分升。6例患者出现并发症:观察到2例严重的腹膜后出血和4例肾细胞癌。讨论了囊性转变的病因及其作为癌前病变的可能作用。