Clinical Investigation

Kidney International (1981) 20, 671–675; doi:10.1038/ki.1981.192

Renal pelvic neoplasms and atypical urothelium in patients with end-stage analgesic nephropathy

Ingemar Blohmé1 and Sonny Johansson1

1Departments of Surgery and Pathology, Sahlgren's Hospital, University of Göteborg, Göteborg, Sweden

Correspondence: Dr I Blohmé, Department of Surgery I, Sahlgren Hospital, 413 45 Göteborg, Sweden

Received 9 June 1980; Revised 6 May 1981.

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Abstract

Renal pelvic neoplasms and atypical urothelium in patients with end-stage analgesic nephropathy. In a series 772 renal transplant patients, 84 had analgesic nephropathy (AN). Four of them had renal pelvic carcinoma. The incidence of atypical urothelial changes of the renal pelvis was studied in 56 AN patients, the majority nephrectomized before or shortly after the renal transplantation. Urothelial atypia, usually bilaterally, was found in 27 patients. Multiple sections resulted in an even higher incidence (8/9). No atypical changes were found in normal kidneys or in end-stage diseased kidneys with other diseases, or in chronically rejected renal allografts. These findings further strengthen the association between intake of phenacetin-containing analgesics and the development of renal pelvic tumors. Patients with end-stage analgesic nephropathy are a high-risk group for developing urinary tract tumors and should be subjected to endoscopic and cytologic surveillance. After renal transplantation, prophylactic bilateral nephroureter-ectomy is advocated.

Néoplasmes pyéliques et épithélium urinaire atypique chez des malades; atteints de néphropathie des analgésiques (AN) au stade terminal. Dans une série de 772 malades traités par transplantation rénale, 84 avaient une AN. Quatre d'entre eux avaient un carcinome pyélique. La fréquence d'atypies de l'épithélium urinaire a été étudiée chez 56 malades atteints d'AN dont la majorité a subi une néphrectomie avant ou peu après la transplantation rénale. Des atypies de l'épithélium urinaire ont été trouvées dans 27 cas, habituellement bilatérales. Des coupes en série ont même montré une fréquence plus grande (8/9). Ces modifications n'ont pas été observées dans des reins normaux ou dans d'autres affections rénales au stade terminal, ou encore dans des séries de rejet chronique. Ces constatations renforcent encore l'association entre l'ingestion d'analgésiques contenant de la phénacétine et le développement de tumeurs pyéliques. Les malades atteints d'AN au stade terminal ont des risques élevés de tumeur de l'appareil urinaire et doivent être soumis à une surveillance endoscopique et cytologique. Après transplantation, la néphrectomie bilatérale prophylactique est recommandée.

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References

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