Denovo urothelial carcinoma of the upper and lower urinary tract in kidney ? transplant patients with end-stage analgesic nephropathy

Abstract

Patients with end-stage analgesic nephropathy bear a higher risk for urothelial cancer than do patients with other renal diseases. In a retrospective study in patients with analgesic nephropathy and kidney transplants we analyzed the prevalence and clinical course of de novo urothelial cancer. Diagnosis of analgesic nephropathy was based on the patients' history and clinical data. Only patients under cyclosporine treatment were included. Between 1968 and 1993, 2,371 kidney transplants were performed on 2,072 patients in the Department of Abdominal and Transplant Surgery. The prevalence of analgesic nephropathy was 3.1%. Of 65 patients with analgesic nephropathy and kidney transplants, 10 (15.4%) developed urothelial carcinoma; 10.8%, bladder cancer; and 9.1%, renal pelvic cancer. The mean age at diagnosis was 56.1 years. Urothelial cancer occurred on average at 33.6 months posttransplantation. On average, 6 of 10 patients with urothelial cancer died of the disease at 16.9 months after the diagnosis. All patients with urothelial bladder cancer had a muscle-infiltrating tumor of moderate or high grade. Since urothelial renal pelvic cancer occurred in 9.1% of our patients with analgesic nephropathy and urological screening is insufficient in patients on dialysis, we suggest that prophylactic nephroureterectomy be performed on one side before transplantation and on the contralateral side at 3-6 months after transplantation. An aggressive approach is indicated in patients with urothelial cancer of the bladder.

Cancer in End-Stage Renal Disease: Potential Factors Involved

“…In a study carried out in 65 patients after renal transplantation due to analgesic nephropathy the following cancers were observed: urothelial carcinoma in 15.4%, bladder cancer in 10.8%, and pelvic cancer in 9.1% [19]. Furthermore, Balkan endemic nephropathy has also been associated with increased formation of urinary tract tumors [20].…”

Laparoscopic Nephroureterectomy to Exclude Upper Urinary Tract Malignancy Associated with Analgesic Nephropathy

“…All patients had muscle-infiltrating tumors (of the bladder, upper tract, or both), and six patients died of TCC despite radical surgery. 15,16 The authors recommended prophylactic unilateral or bilateral nephroureterectomy before renal transplantation. 15,16 Swindle and colleagues 17 also found a tendency to high-grade and high-stage TCC associated with a poor outcome in patients with analgesic nephropathy.…”

“…4,[8][9][10][11][12][13][14][15][16][17][18][19] Because TCC may become even more aggressive under immunosuppression, some transplant centers perform routine bilateral nephroureterectomies before or after renal transplantation in analgesic abusers with ESRD to exclude TCC of the upper urinary tract. 15,16,20,21 Minimally invasive techniques such as laparoscopy have been developed in various medical disciplines with the view of achieving the same result as open surgical procedures with the same safety for the patient and less trauma. Procedures such as laparoscopic nephrectomy have become routine at specialized centers, and even pediatric, geriatric, and high-risk patients such as transplant or dialysis patients have been selected for laparoscopy.…”

Transitional Cell Carcinoma Involving the Ureterovesical Part of a Transplanted Ureter

“…According to the data of Thon et al [3], 6 of 10 kidney transplant patients with urothelial cancer died of the disease at an average of 16.9 months after diagnosis. These results justify an aggressive approach to the treatment of bladder cancer in renal transplant recipients with extensive surgery and chemotherapy [3]. Our patient refused radical operative treatment and/or treatment with chemotherapy and de- manded continuation of the immunosuppressive therapy in order to preserve the kidney graft.…”