Veltman G A, Bosch F H, van der Plas-Cats M B, van Leusen R
Department of Internal Medicine, Hospital Rijnstate, Arnhem, The Netherlands.
Nephrol Dial Transplant. 1991;6(5):346-8. doi: 10.1093/ndt/6.5.346.
The abuse of analgesic-containing drugs leads to chronic nephropathy with an increased risk of developing a transitional-cell carcinoma of the urinary tract. In our experience follow-up is often stopped or has never been started when patients present for dialysis. We use urine cytology as the screening method. Nine of the 138 patients entering dialysis between 1980 and 1990 had analgesic nephropathy. In three patients urine cytology led to a suspicion of malignancy. Cystoscopy and/or retrograde pyelography showed a carcinoma of the renal pelvis in two patients and a carcinoma of the bladder in one patient. The patients with carcinoma of the renal pelvis died of cardiovascular complications within 2 years of nephroureterectomy. An autopsy was performed in one of these patients and there were no residual tumours or metastases. In the other patient autopsy was not performed, but urine cytology again suggested malignancy. The patient with a carcinoma of the bladder is still alive. She was treated with transurethral resection of the tumour and etoglucide instillations. We conclude that urine cytology is a good screening method for the early detection of transitional-cell carcinomas in dialysis patients with analgesic nephropathy.
含镇痛药药物的滥用会导致慢性肾病，并增加患泌尿道移行细胞癌的风险。根据我们的经验，当患者前来接受透析时，随访往往会停止或从未开始过。我们使用尿液细胞学作为筛查方法。在1980年至1990年间开始透析的138例患者中，有9例患有镇痛药性肾病。在3例患者中，尿液细胞学检查引发了对恶性肿瘤的怀疑。膀胱镜检查和/或逆行肾盂造影显示，2例患者患有肾盂癌，1例患者患有膀胱癌。肾盂癌患者在肾输尿管切除术后2年内死于心血管并发症。其中1例患者进行了尸检，未发现残留肿瘤或转移灶。另一例患者未进行尸检，但尿液细胞学检查再次提示为恶性肿瘤。膀胱癌患者仍然存活。她接受了经尿道肿瘤切除术和依托必利灌注治疗。我们得出结论，尿液细胞学检查是早期发现患有镇痛药性肾病的透析患者移行细胞癌的良好筛查方法。
