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Isao Ishikawa, MD, Division of Nephrology, Department of Internal Medicine, Kanazawa Medical University, Uchinada, Kahoku, Ishikawa 920-02 (Japan) Dear Sir, Acquired cystic disease of the kidney is a disease first identified in the process of the remarkable advance in the treatment of chronic renal failure [1, 2] and has recently been delineated as a pathological and clinical entity [3]. Cyst fluid chemistries in acquired cystic disease of the kidney have not been reported so far. The analysis of cyst fluid chemistries may contribute to knowledge of the pathogenesis of acquired cysts, i.e. whether acquired cystic disease is related to simple cysts or adult-type polycystic kidney disease, or whether it is related to neither of them. We analyzed 17 acquired cysts in 2 autopsy cases (47 and 58 years of age, males) who had been on hemodialy-sis for more than 10 years (10 and 13 years) due to chronic glomerulonephritis. Sodium, potassium, chloride, urea nitrogen, creatinine, and total protein were measured in cyst fluid and serum by automatic analysis (Smac®; Tech-nicon). The serum levels were obtained at steady state (prior to dialysis) and agonal state or 30 min after death. The cyst fluid was obtained at autopsy, which was performed within 30 min or 2 h of the patients’ demise. Three patients with simple cysts and 1 patient with polycystic kidney disease were also evaluated as controls. The results are listed in table I. Sodium, potassium, chloride and urea nitrogen of the cyst fluid in acquired cysts were similar to those of the respective sera. The sodium of cyst fluid in acquired cysts was 138–160 (146.1 ± 6.0 mEq/1; mean ± SD). The ratios of cyst fluid to serum creatinine were high, 7.1 and 5.4, respectively. The creatinine levels of cyst fluid in acquired cysts were Table I. Ratio of cyst ñuid to serum for selected solutes Diagnosis Number of Number of Sodiumpatients cysts analyzed Potassium Urea Creatinine Total protein

Unusual Composition of Cyst Fluid in Acquired Cystic Disease of the End-Stage Kidney