Six hemodialysis patients with associated urothelial cancers (one renal pelvic, ureteral and bladder cancer, five bladder cancers) treated at the Department of Urology, Tokyo Metropolitan Toshima Hospital, between January 1983 and December 1992 were investigated.
The chief complaint was gross hematuria in all six cases. The duration of hemodialysis until the cancers were found, was 1 to 96 months, and in four cases the cancers were found within two years. Three patients were treated by transurethral resection, and the others were treated by total cystectomy (one case also underwent total nephroureterectomy). Pathological diagnosis was grade 3 in all cases, and three patients had invasive cancers.
Lymphocytes were less 1, 000/mm³ in four cases, and their responses to the lymphocyte stimulating test were poor. However, all classes of immunological globulins were normal in all cases. Immuno-suppressive acidic protein was higher in all cases than in normal controls. These results indicate that immunity, especially cellular immunity, may be decreased in hemodialysis patients.
The data suggest that lower cellular immunity during hemodialysis may be responsible for the carcinogenesis of urothelial tumors and their rapid progression. Care should be taken in dealing with hematuria during hemodialysis, and examinations for urothelial cancer are mandatory.