Abstract
Patients with end-stage renal failure due to analgesic nephropathy have an increased risk of developing a urothelial carcinoma. To determine the impact of renal transplantation on the frequency of urothelial carcinomas, we analyzed 2072 patients who underwent 2371 renal transplantations between 1968 and 1993, including 78 (3.8%) with clinically proven analgesic nephropathy. Before and after transplantation a regular tumor screening was performed in patients with analgesic nephropathy by urine cytology and abdominal sonography. In 11 of the 78 patients with analgesic nephropathy (14.1%; age 51–66 years, 40–108 months after initiation of dialysis treatment, 5–77 months after transplantation), a urothelial carcinoma of the native urinary tract, especially the kidneys, was diagnosed. Therapy comprised nephroureterectomy (n=6), transurethral resection (n=6) and/or cystectomy (n=2). Seven patients died due to tumor progression 16.3 (4–33) months postoperatively and one patient died due to a perioperative complication. Despite regular tumor screening after transplantation, the diagnosis of a urothelial carcinoma was made very late, leading to a high tumor-related mortality. As a consequence, we suggest that a bilateral nephroureterectomy should be performed prophylactically in patients with proven analgesic nephropathy. In addition, a cystoscopy with lavage cytology testing of the bladder should be performed twice a year.
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References
Ballé C, Schollmeyer P (1990) Morbidity of patients with analgesic-associated nephropathy on regular dialysis treatment and after renal transplantation. Klin Wochenschr 68:38–42
Bengtsson U, Angervall L, Ekman H, Lehmann L (1968) Transitional cell tumors of the renal pelvis in analgesic abusers. Scand J Urol Nephrol 2:145–150
Bengtsson U, Johansson S, Angervall L (1978) Malignancies of the urinary tract and their relation to analgesic abuse. Kidney Int 13:107–113
Blohme I, Johansson S (1981) Renal pelvic neoplasms and atypical urothelium in patients with end-stage analgesic nephropathy. Kindey Int 20:671–675
Blute ML, Segura JW, Patterson DE, Benson RC, Zincke H (1989) Impact of endourology on diagnosis and management of upper urinary tract urothelial cancer. J Urol 141:1298–1301
Brunner FP, Richtmann L, Thiel G, Dubach UC (1978) Tumoren der ableitenden Harnwege und Analgetikaabusus. Schweiz Med Wochenschr 108: 1013–1019
Charbit L, Gendreau MC, Mee S, Cukier J (1991) Tumors of the upper urinary tract: 10 years of experience J Urol 146:1243–1246
Ekman P (1990) Tumors of the upper urinary system: diagnostic procedures. In: Murphy G, Khoury S, Chateloin C, Denis L (eds) Recent advances in urological cancers. Diagnosis and treatment. III: Upper tract. Pergamon, New York, pp 151–154
Eriksson O, Johansson S (1976) Urothelial neoplasms of the upper urinary tract. A correlation between cytologic and histologic findings in 43 patients with urothelial neoplasms of the renal pelvis or ureter. Acta Cytol 20: 20–25
Gonwa TA, Corbett WT, Schey HM, Buckalew VM (1980) Analgesic-associated nephropathy and transitional cell carcinoma of the urinary tract. Ann Intern Med 93:249–252
Hauser AC, Derfler K, Stockenhuber F, Balcke P (1990) Post-transplantation malignant disease in patients with analgesic nephropathy. Lancet 1:335
Hruby W von, Stellamor K, Zinner G, Marberger M (1983) Der Nierenbekkentumor im Sonogramm. Fortschr Roentgenstr 138:469–472
Hultengren N, Lagergren C, Lungqvist A (1965) Carcinoma of the renal pelvis in renal papillary necrosis. Acta Chir Scand 130:314–320
Leistenschneider W, Nagel R (1979) Lavage-Zytologie bei pathologischen Veränderungen in Nierenbecken und Harnleiter. Akt Urol 10:35–43
Lornoy W, Morelle V, Becaus I, Fonteyne E, Vrouwziekenhus OL (1979) Analgesic nephropathy. N Engl J Med 300:319–320
McCredie M, Ford JM, Taylor JS, Stewart JH (1982) Analgesics and cancer of the renal pelvis in New South Wales. Cancer 49:2617–2625
McCredie M, Stewart JH, Ford JM, McLennan RA (1983) Phenacetin containing analgesics and cancer of the bladder or renal pelvis in women. Br J Urol 55:220–224
Mihatsch MJ, Knüsli C (1982) Phenacetin abuse and malignant tumors: an autopsy study covering 25 years (1953–1977). Klin Wochenschr 60:1339–1349
Milestone B, Friedman AC, Seidmon EJ, Radecke PD, Leff-Toave AS, Caroline DF (1990) Staging of ureteral transitional cell carcinoma by CT and MRI. Urology 36:346–349
Nanra RS (1983) Renal effects of antipyretic analgesics. Am J Med 75:70–81
Netto NR, Almeida Claro JF (1990) CT scanning in the diagnosis of pelvicalyceal filling defects. Arch Exp Urol 43: 683–685
Penn I (1991) Post-transplant kidney cancers and skin cancers (including Kaposi's sarcoma). In: Schmähl D, Penn I (eds) Cancer in organ transplant recipients. Part I. Springer, Berlin Heidelberg New York London Paris Tokyo Hong Kong Barcelona Budapest, pp 46–53
Penn I (1995) Primary kidney tumors before and after renal transplantation. Transplantation 59:480–484
Schwarz A, Offermann G, Keller F (1992) Analgesic nephropathy and renal transplantation. Nephrol Dial Transplant 7:427–432
Valderrábano F, Jones EHP, Mallick NP (1995) Report on management of renal failure in Europe, XXIV, 1993. Nephrol Dial Transplant 10 [Suppl 5]:1–25
Vogt P, Frei U, Repp H, Bunzendahl H, Oldhafer K, Pichlmayr R (1990) Malignant tumours in renal transplant recipients receiving cyclosporin: survey of 598 first-kidney transplantations. Nephrol Dial Transplant 5:282–288
Ward JN, Pitts WR Jr, Bard RH (1992) The dangerous ureter, Urology 39:322–326
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Kliem, V., Thon, W., Krautzig, S. et al. High mortality from urothelial carcinoma despite regular tumor screening in patients with analgesic nephropathy after renal transplantation. Transpl Int 9, 231–235 (1996). https://doi.org/10.1007/BF00335391
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DOI: https://doi.org/10.1007/BF00335391