Polycystic kidneys, renal hamartomas, their variants and complications

Meta analysis of the relationship between tuberous sclerosis complex and renal cell carcinoma

The association of angiomyolipoma with tuberous sclerosis complex (TSC) patients is well recognised. Some literature has suggested that patients with TSC are at increased risk of renal neoplasm, particularly since angiomyolipomas can be locally invasive and demonstrate tumor like neovascularity on angiography. In an attempt to place in context one case of metastatic renal cell carcinoma in a patient with TSC a meta analysis of the literature was performed. One pediatric patient with TSC and metastatic renal cell carcinoma was evaluated. Reviews and case reports of TSC and renal cell carcinoma and related imaging findings were identified by searching the MEDLINE database, the 'bibliography of reviews' in Index Medicus, personal files and the reference lists from all identified reviews. Individual cases suitable for review in the available literature from 1922 through 1993 comprised the data base. The data base was analysed with the method of proportions and unpaired two-tailed Student's t-test for different populations. A cumulative summary of the literature amassed 107 additional cases from 62 reports over 71 years. Our case is the 17th case, to our knowledge, of renal cell carcinoma in TSC. Analysis of the distribution of characteristics and incidence of; renal cysts, renal cell carcinoma, and lymph node involvement demonstrate no increased risk of renal cell carcinoma in patients with TSC (P = NS). Though anecdotal evidence has suggested a relationship between TSC and renal cell carcinoma, meta analysis of cases of coincident TSC renal complex, cystic changes, angiomyolipoma and renal cell carcinoma implies an identical, though small, risk of malignancy in TSC patients as compared with the normal population.

Angiographic management of retroperitoneal hemorrhage from renal angiomyolipoma in polycystic kidney disease

Angiographic management of bilateral angiomyolipomas complicated by hemorrhage in autosomal dominant polycystic kidney disease is presented. The patient had mild stigmata of tuberous sclerosis, and a family history of tuberous sclerosis and autosomal dominant polycystic kidney disease. The radiographic features at diagnosis, and those present during and after embolization are described. Radiological criteria for diagnosis and successful control of bleeding with intra-arterial selective embolization are discussed. Radiographic features before, during and after embolization are exhibited.

Bilateral angiomyolipomas and renal cell carcinoma in polycystic kidney

A case is presented of a twenty-eight-year-old man in whom renal failure developed at age twenty-four from polycystic kidney disease known to be present since childhood. He also had cutaneous manifestations of the tuberous sclerosis complex. Intrarenal hemorrhage led to bilateral nephrectomy. Microscopic examination disclosed typical polycystic disease and multiple angiomyolipomas in each kidney. In addition several renal cell carcinomas of oncocytic, papillary, and clear cell type were found. Review of the literature disclosed the uncommon coexistence of any two of these lesions and did not uncover any reported case of the simultaneous existence of all three.

Adult polycystic kidney disease: a review of 100 cases

Herein we review 100 cases of adult polycystic kidney disease. Flank pain was the most common presentation in these cases. In 20% of the patients calculi were noted and 10% had obstruction. The average patient age at death was 57 years. The importance of tomography is emphasized with key radiographic features, such as bilateral large kidneys, inhomogeneous nephrogram, caliceal distortion and poorly defined renal margins. Cystic involvement of the liver and spleen may help to confirm the diagnosis. Differential diagnosis includes bilateral multiple simple cysts, angiomyolipomatosis and bilateral renal carcinomas.

Clinical and radiographic findings of focally infected polycystic kidneys

Three patients with localized polycystic kidney infections are presented with the pertinent clinical, laboratory, and radiographic findings. Gallium-67 citrate and angiography play an important role in evaluation of these patients. Angiography in particular is valuable in the diagnosis and the exact localization of the inflammatory disease. Localization is extremely important in planning surgical treatment should conservative therapy fail.

Polycystic renal disease--occurrence of malignant change and role of nephrectomy in potential transplant recipients

28 cases of malignant renal neoplasms in patients with polycystic kidneys are reviewed from the literature and 2 new cases are reported. The difficulty in diagnosing this malignant change together with the increased survival of patients with polycystic kidneys on dialysis and transplant programmes leads to the recommendation that all such patients should be considered for nephrectomies. The reasons for this recommendation and its advantages and disadvantages are discussed.

Renal angiomyolipoma in adult-type polycystic disease

Two adults with renal angiomyolipomas and polycystic disease are presented with emphasis on the angiographic manifestations of the coexisting lesions. One patient had multiple episodes of gross hematuria and a perinephric abscess which resulted in bilateral nephrectomies; the second presented with hypertension and underwent unilateral nephrectomy to treat a hypervascular tumor. The clinical and radiographic diagnoses of the combined lesions are discussed and suggestions for management offered.

The radiological diagnosis of "avascular" renal tumours

In the past 9 years we have encountered 3 renal space-occupying lesions, which were "avascular" at arteriography but which appeared to be tumours, as shown by renal puncture of "antegrade" pyelography, All had an irregular inner border demonstrated. The investigation and radiological diagnosis of such masses is discussed thad compared with that of renalcysts.