Analgesic Abuse, Renal Parenchymal Disease and Carcinoma of the Kidney or Ureter

Abstract

In a consecutive series of 88 cases of carcinoma of the kidney and upper urinary tract seen at one hospital, 31 had malignant urothelial tumours of the renal pelvis or ureter. Forty-two per cent of these transitional-cell carcinomas occurred in patients with renal papillary necrosis following upon prolonged and heavy analgesic ingestion. Other possible aetiological factors were heavy cigarette smoking (61% of cases), long standing urinary obstruction or infection (23%) and possible occupational exposure (6%); in only four cases (13%) was there no identifiable aetiological factor. Those cases with analgesic nephropathy were characterised by renal functional impairment, hypertension and interstitial nephritis, but there was no difference in the clinical behaviour or pathological appearances of the tumours in the two groups. The clinical and experimental evidence that certain metabolites of phenacetin are carcinogenic is reviewed.

Transitional cell carcinomas of the renal pelvis and the ureter: comparative demographic characteristics, pathological grade and stage and 5‐year survival in a Taiwanese population

“…TCC of the ureter and RP is relatively rare outside Taiwan; in the present study, the upper tract comprised 23% of all urothelial TCCs, and RPUC accounted for 63% of the kidney tumours, which is 4– and 6–10 times, respectively, higher than rates reported in other countries [2,3,9–11]. The higher incidence of upper tract TCC might be associated with arsenic exposure, smoking, analgesic abuse, occupational carcinogens, hypertension, long‐standing urinary obstructions, infection and Balkan nephropathy [12–17]. However, the incidence of upper tract TCC did not significantly differ between patients who had lived in endemic areas of BFD and those who had lived outside these areas.…”

Regular use of analgesics is a risk factor for renal cell carcinoma

“…Chronic use of analgesics was first linked to the development of kidney cancer through a series of case reports which documented cancer of the renal pelvis occurring in heavy users of phenacetin (Bengtsson et al, 1968;Mahony et al, 1977). These uncontrolled observations were later confirmed by a number of case-control studies conducted in diverse populations (McCredie et al, 1982;McLaughlin et al, 1985;Jensen et al, 1989).…”

Phenacetin‐Containing Analgesics and Cancer of the Bladder or Renal Pelvis in Women

“…In contrast to the many case reports of analgesic-associated renal pelvic cancer, only a few reports of cases of bladder cancer with this association have been published (Bengtsson et al, 1968;Rathert et al, 1975), despite the fact that this tumour is some 10 to 15 times more common in women than cancer of the renal pelvis in Western societies where analgesic consumption is common (Waterhouse et af., 1976). However, second tumours in the ureter or bladder are not infrequent in patients with analgesicassociated cancer of the renal pelvis (Bengtsson et al, 1968;Rathert et al, 1975;Mahony et al, 1977) and in the only case-control study of bladder cancer examining analgesics as a possible risk factor, there was a four-fold risk for this cancer with Accepted for publication 20 August 1982.…”