Renal carcinoma associated with end-stage kidney disease: A case series from a tertiary Portuguese hospital

End-stage kidney disease (ESKD) is associated with a higher incidence of renal cell carcinoma (RCC). Here we report a case series of 56 patients with ESKD who underwent radical nephrectomy for suspected renal masses at a tertiary hospital in Portugal from January 2017 to January 2024. Patient records were reviewed retrospectively to collect clinical, surgical, and pathological data. Among these patients, 12 had benign tumors, while 44 were diagnosed with malignant tumors, accounting for approximately 78.5% of the cohort. The histological analysis revealed the following distribution: clear cell RCC (20 cases, 45%), papillary RCC (11 cases, 25%), ACKD-associated RCC (6 cases, 14%), clear cell papillary RCC (4 cases, 9%), and chromophobe RCC (3 cases, 7%). Notably, the majority of patients (95.5%) had stage I malignant tumors, yet the prognosis for patients with ESKD was poorer compared to non-ESKD patients, with 7 patients succumbing during the follow-up period. This study underscores the complex relationship between ESKD and RCC, highlighting the challenges in diagnosis and management. Despite regular monitoring leading to early detection of tumors, the overall prognosis remains adversely affected by the compromised immune status and comorbid conditions prevalent in this population. The findings call for enhanced surveillance and personalized management strategies for RCC in patients with ESKD.