The cystic degeneration and carcinogenesis of the kidney

1.囊肿和肾细胞癌的流行病学：长期血液透析的患者在成人中有发展为获得性肾囊肿病（ACDK）的明确趋势，如果他们是儿童，则易于形成鲍曼囊上皮的胚胎性增生。透析患者中肾细胞癌（RCC）的发病率是一般人群预期发病率的6.3倍。我们收集了来自385个诊所的5779例RCC，其中223例（3.9%）合并肾囊肿。在这223例病例中，32%合并有单纯囊肿，28%合并有ACDK，9%合并有多房囊肿。血液透析患者的多发性和/或双侧肿瘤发生率高于未接受血液透析治疗的患者。血液透析患者中低分期肿瘤的比例也较高.肾囊肿和肾癌的发病机制。肾小管上皮细胞增生可能是囊肿形成的原因， ...更多信息 用MDCK细胞测定其促囊肿形成活性，评价其促囊肿形成活性。上皮增生和随后的囊肿形成可能会导致恶性肿瘤的风险增加。在这项研究中获得了一些支持性证据。在实验性药物性肾囊肿中，C-myc基因在肾小管组织中被瞬时识别。囊液和囊壁中谷胱甘肽（众所周知的脱氧辅酶之一）的水平显著较低，表明可能在囊上皮中诱导活性氧毒性。囊壁上皮细胞的某些抗原性不同于正常近端或远端肾小管上皮细胞表面的抗原性。免疫组化结果显示囊壁具有癌前病变的倾向。另一方面，维持性血液透析患者的肾囊肿数量在肾移植后随着时间的推移而减少。淋巴细胞介导的细胞毒性和PBL细胞因子的产生显着抑制在某些患者在维持性血液透析5年内的治疗启动相比，在normalcontrols.From上述findings.肾衰及其相关的免疫学改变，连同肾囊肿的形成，是主要的因素，包含负责任的机制较高频率的发展肾细胞癌在血液透析患者。少

1. Epidemiology on cyst and RCC.Patients exposed to long-term hemodialysis has definite tendency to develop the acquired renal cystic disease of kidney (ACDK) in adults and are predisposed to form of embryonal hyperplasia of bowman's capsular epithelium if they are children. Incidence of renal cell carcinoma (RCC) in dialysis patients is 6.3 fold the expected rates in the general population. We collected 5779 cases of RCC from 385 clinics, out of which 223 cases (3.9%) were associated with renal cysts. On these 223 cases, 32% of them were associated with a simple cyst, 28% with ACDK and 9% with multilocular cyst. The incidence of multiple and/or bilateral tumors was higher in patients on hemodialysis than patients without having hemodialysis treatment. The percentage of low stage tumor was also higher in hemodialysis patients.2. Pathogeneses of renal cyst and cancer.Hyperplasia of renal tubular epithelium appeared to be responsible for cyst formation which probably was regulated partia … More lly by several cytokines, such as EGF, TGF-beta, IL-6 and so on. Their activity was estimated by measuring cyst formation promoting activity using MDCK cells. The epithelial hyperplasia and subsequent formation of cyst may induce an increased risk for malignancy. Several supporting evidences were obtained in this study. In experimental drug-induced renal cystic disease, C-myc gene was transiently recognized in renal tubular tissues. Level of glutathione, which is well known as one of deoxidation coenzymes, in both cystic fluid and cyst wall, was significantly low suggesting the possibility that active oxygen toxicity can be induced in the cystic epithelium. Some of the antigenicities on epithelial cells of the cyst wall differed from that on the surface of normal proximal or distal tubular epithelium. In addition, immunohistochemical analysis indicated that the cyst wall of ACDK showed a kind of precancerous predisposition. On the other hand, number of the renal cysts in patients on maintenance hemodialysis was founded to decrease with time after renal transplantation. Lymphocyte-mediated cytotoxicity and cytokine production by PBL were significantly suppressed in some patients on maintenance hemodialysis within 5 years of the therapy initiation as compared to those in normal controls.From above findings.Renal failure and its associated immunological alteration, together with formation of renal cysts, are major factors containing responsible mechanisms for higher frequency of development of RCC in hemodialysis patients. Less