The cystic degeneration and carcinogenesis of the kidney

1. 囊肿和肾细胞癌的流行病学。长期接受血液透析的患者在成人中有发展为获得性肾囊性肾病（ACDK）的明确倾向，如果他们是儿童，则容易形成鲍曼囊上皮的胚胎性增生。肾细胞癌（RCC）在透析患者中的发病率是一般人群预期发病率的6.3倍。我们从385个诊所收集了5779例RCC病例，其中223例（3.9%）与肾囊肿相关。在这223例病例中，32%合并单纯性囊肿，28%合并ACDK， 9%合并多房性囊肿。接受血液透析治疗的患者多发和/或双侧肿瘤的发生率高于未接受血液透析治疗的患者。低期肿瘤在血液透析患者中的比例也较高。肾囊肿和癌的发病机制。肾小管上皮增生是囊肿形成的主要原因，可能部分受EGF、tgf - β、IL-6等多种细胞因子的调控。它们的活性是通过测量MDCK细胞促进囊肿形成的活性来估计的。上皮增生和囊肿的形成可能会导致恶性肿瘤的风险增加。本研究获得了几个支持性证据。在实验性药物性肾囊性疾病中，C-myc基因在肾小管组织中被短暂识别。囊液和囊壁中谷胱甘肽（一种众所周知的脱氧辅酶）的水平均明显低，提示囊上皮可能诱导活性氧毒性。囊肿壁上皮细胞的一些抗原性不同于正常近端或远端小管上皮表面的抗原性。此外，免疫组化分析表明，ACDK的囊肿壁显示出一种癌前倾向。另一方面，维持性血液透析患者的肾囊肿数量随着肾移植后时间的延长而减少。与正常对照组相比，在一些接受维持性血液透析治疗的患者中，PBL介导的淋巴细胞毒性和细胞因子产生在治疗开始后的5年内明显受到抑制。根据以上发现。肾功能衰竭及其相关的免疫改变，以及肾囊肿的形成，是血液透析患者发生肾细胞癌频率较高的主要因素。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