Medline ® Abstracts for References 1-3

In a series of 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 nephroureterectomy is advocated.

A case-control study was undertaken to determine whether renal papillary necrosis (RPN) is an essential step in the genesis of analgesic-associated cancer of the renal pelvis (CaP). Kidneys of 66 patients (and 86 cases of renal parenchymal cancer (CaK), for comparison) were examined for evidence of RPN. Information concerning past consumption of phenacetin-containing analgesics (PhA) was obtained from all cases and 751 population controls by means of a questionnaire. Separately, RPN and regular consumption of PhA each conferred a relative risk for CaP of 3-1/2 to 7, while together they increased the risk some 20 times that for non-consumers without RPN. This suggests that each factor has independent, and when they coexist sequential, effects. The risk for CaK was doubled by regular PhA consumption but was not increased by RPN.

We investigated the use of analgesics containing phenacetin or acetaminophen in 173 young women with urinary bladder cancer and 173 matched controls. The cases, who were 20 to 49 years old at the time of diagnosis of cancer, were 6.5 times more likely to report regular use of analgesics containing phenacetin at least one year before diagnosis than were their matched controls (odds ratio, 6.5; 95 per cent confidence interval, 1.5 to 59.2). Among the 15 women (13 cases and 2 controls) reporting regular use of phenacetin-containing drugs, 8 of the cases and 1 of the controls reported daily use for over one year (P = 0.04). Excessive use of analgesics containing acetaminophen was not reported. The increased risk of bladder cancer in young women who regularly used phenacetin-containing products remained present after adjustments for all other identified risk factors.