title: Tumours in end-stage kidney.
abstract: OBJECTIVE
  Patients with end-stage kidney disease (ESKD) show a greater risk for renal cell carcinoma (RCC), which tends to be multifocal and bilateral. The malignant potential is unclear. The question is whether to remove both kidneys in patients with a tumor on one side only diagnosed by computed tomography (CT).
  
  
  METHODS
  Kidney tumors were found in 14 patients with ESKD from January 2002 to December 2006. One was unfit for surgery. Thirteen patients underwent nephrectomy and 6 a bilateral procedure of whom only 2 had bilateral tumors on CT, 3 multiple tumors on the contralateral side, and 1 uncontrollable hypertension with tumors as an incidental finding. Tumors were found in all 19 specimens.
  
  
  RESULTS
  In 13 kidneys (68.4%), the tumors were multiple; in 6 (31.6%), solitary. The types of tumor were: 13 (68.4%) papillary RCCs (PRCC), 9 (47.4%) clear RCCs (CRCC), a combination of PRCC and CRCC in 4 (21.0%), and myxoid liposarcoma (with solitary PRCC contralaterally). The mean follow-up was short (19 +/- 15 months; maximum, 54 months). Only 1 patient died due to a tumor at 16 months after operation.
  
  
  CONCLUSIONS
  There is a high risk for bilateral involvement. Patients who undergo unilateral nephrectomy must be regularly followed and contralateral nephrectomy carefully considered, mainly in transplanted patients on immunosuppression. Further studies are needed to give a definitive answer about the indications for surgery and the indications for contralateral nephrectomy as well. To date, prophylactic contralateral nephrectomy should not be a therapeutic standard.
authors.affiliation: Department of Urology, Charles University Hospital, Plzen, Czech Republic. horam@fnplzen.cz
authors.forename: M
authors.initials: M
authors.lastname: Hora
authors.forename: O
authors.initials: O
authors.lastname: Hes
authors.forename: T
authors.initials: T
authors.lastname: Reischig
authors.forename: T
authors.initials: T
authors.lastname: Urge
authors.forename: J
authors.initials: J
authors.lastname: Klecka
authors.forename: J
authors.initials: J
authors.lastname: Ferda
authors.forename: M
authors.initials: M
authors.lastname: Michal
authors.forename: V
authors.initials: V
authors.lastname: Eret
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D006435:Renal Dialysis; D018570:Risk Assessment; D012744:Sex Ratio; D014057:Tomography, X-Ray Computed