Studies on Certain Urinary and Blood Serum Enzymes in Bilharziasis and their Possible Relation to Bladder Cancer in Egypt

Abstract

THE relation of bilharziasis and bladder cancer in Egypt is of interest and some preliminary results on the urinary excretion of certain tryptophan metabolites were reported in these conditions (Abul-Fadl and Khalafallah, 1961).The present work considers the enzymological aspect of the problem, since the role of certain enzymes particularly the /8-glucuronidase in the mechanism of the bladder cancer production has been frequently discussed (Boyland, Wallace and Williams, 1957; Boyland, Gasson and Williams, 1957). An increase in the urinary 8-glucuronidase excretion in schistosomiasis was reported by Fripp (1960) in West Africa. In a recent communication to the International Symposium on Bilharziasis held at Cairo in March 1962, the authors reported an elevated f8-glucuronidase enzyme content in the living Schistozoma haematobium ova obtained from fresh infected urines (Abul-Fadl and Metwalli, 1962).The urinary ,-glucuronidases, acid and alkaline phosphatases, blood serum alkaline phosphatases and transaminases have been estimated in 30 normal Egyptians, 82 simple bilharzial infections, 92 bilharziasis with hepatosplenomegaly, 102 bladder cancer patients with definite bilharzial history and 12 cases without bilharzial history. MATERIAL AND METHODSThe materials for this study were collected from among patients of both the out and inpatients sections of the medical, surgical and radiological departments of the Kasr-el-Aini Cairo University Hospitals. In each case the clinical diagnosis was assessed by the medical staff. Blood-sera, free from haemolysis, were prepared from blood specimens taken from fasting patients.Complete 24 hour urine collections were obtained under toluene-benzene mixture. These were subjected to routine examination of physical properties, abnormal constituents and microscopical examination before determining the different enzyme activities.Urinary /?-glucuronidase activity was determined following the method described by Abul-Fadl (1957) with all the precautions mentioned. The enzyme activity was determined at pH 4.5 before and after dilution with protamine and at pH 5-2 without dilution. The total output of the enzyme activity per 24 hours was also taken into consideration, the extent of enzyme activation after dilution

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

“…This hypothesis would explain the localization of analgesic-associated tumours in the renal pelvis rather than the bladder, a more usual site for chemical carcinogenesis, and is not inconsistent with the previously described occurrence of transitional-cell tumours in patients with schistosomiasis40, calculous disease" and other inflammatory conditions of the urinary tract?, 4 1 In this context, it should be noted that the incidence of cancer in papillary necrosis is much higher than in other forms of chronic pyel~nephritis~, and more comparable to that in schistosomiasis, in which activation of endogenous carcinogens by the infecting parasite has been implicated. 42,43 Since, in the majority of patients with analgesic nephropathy, death from renal failure can be avoided by careful conservative management or by successful dialysis or transplantation, the probability of developing transitional-cell carcinoma may now be greater than before the establishment of chronic renal failure programmes. It is our current policy to investigate by cystoscopy and retrograde pyelography the appearance of macroscopic or microscopic haematuria in patients with analgesic nephropathy, and there may be a case for routine cytological screening of urine from all such patients.44 It is doubtful whether bilateral nephro-ureterectomy can be justified for transplant recipients with papillary necrosis since there has not yet been reported any case of carcinoma of the renal pelvis or ureter in the Australasian renal transplant p r~g r a m r n e .~~ That abuse of analgesics is a cause of cancer is not yet certain, but the mounting clinical and biochemical evidence of their carcinogenicity can no longer be ignored.…”