title: Computed tomography of renal cell carcinoma in patients with terminal renal impairment.
abstract: OBJECTIVE
  An increased incidence of renal tumors has been observed in patients with end-stage-renal-disease (ESRD). The very strong association with acquired renal cystic disease (ACRD) and increased incidence of the renal tumors (conventional renal cell carcinoma (CRCC), papillary renal cell carcinoma (PRCC) or papillary renal cell adenoma (PRCA)) was reported. This study discusses the role of computed tomography (CT) in detecting renal tumors in patients with renal impairment: pre-dialysis, those receiving dialysis or with renal allograft transplants.
  
  
  METHODS
  Ten patients (nine male, one female) with renal cell tumors were enrolled into a retrospective study; two were new dialysis patients, three on long-term dialysis, and five were renal transplant recipients with history of dialysis. All patients underwent helical CT, a total of 11 procedures were performed. Sixteen-row detector system was used five times, and a 64-row detector system for the six examinations. All patients underwent nephrectomy of kidney with suspected tumor, 15 nephrectomies were performed, and 1 kidney was assessed during autopsy. CT findings were compared with macroscopic and microscopic assessments of the kidney specimen in 16 cases.
  
  
  RESULTS
  Very advanced renal parenchyma atrophy with small cysts corresponding to ESRD was found in nine patients, chronic pyelonephritis in remained one. A spontaneously ruptured tumor was detected incidentally in one case, patient died 2 years later. In the present study, 6.25% (1/16) were multiple PRCA, 12.5% (2/16) were solitary PRCC, 12.5% tumors (2/16) were solitary conventional renal cell carcinomas (CRCC's), 12.5% tumors (2/16) were multiple conventional renal cell carcinomas (CRCC's), 25% (4/16) were CRCC's combined with multiple papillary renal cell carcinomas with adenomas (PRCC's and PRCA's), and 25% (4/16) of the tumors were multiple PRCC's combined with PRCA's without coexisting CRCC's. Bilateral renal tumors were found in our study in 60% (6/10) confirmed in six cases, one kidney left on follow-up due to the small tumors.
  
  
  CONCLUSIONS
  With the use of a multi-detector row system, it is possible to detect smaller foci suspected to originate in multiple tumors, especially when up to 3-mm thin multi-planar reconstructions are used. Two cases demonstrated the possibility the development of RCC in impaired kidneys may start before dialysis initiation.
authors.affiliation: Department of Radiology, Charles University Hospital Plzen, Alej Svobody 80, CZ-306 40 Plzen, Czech Republic. ferda@fnplzen.cz
authors.forename: Jirí
authors.initials: J
authors.lastname: Ferda
authors.forename: Milan
authors.initials: M
authors.lastname: Hora
authors.forename: Ondrej
authors.initials: O
authors.lastname: Hes
authors.forename: Tomás
authors.initials: T
authors.lastname: Reischig
authors.forename: Boris
authors.initials: B
authors.lastname: Kreuzberg
authors.forename: Hynek
authors.initials: H
authors.lastname: Mírka
authors.forename: Eva
authors.initials: E
authors.lastname: Ferdová
authors.forename: Kristýna
authors.initials: K
authors.lastname: Ohlídalová
authors.forename: Jan
authors.initials: J
authors.lastname: Baxa
authors.forename: Tomás
authors.initials: T
authors.lastname: Urge
mesh_terms: D000328:Adult; D002292:Carcinoma, Renal Cell / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000000981:diagnostic imaging*; D007680:Kidney Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods*