Kliem V, Thon W, Krautzig S, Kolditz M, Behrend M, Pichlmayr R, Koch K M, Frei U, Brunkhorst R
Department of Nephrologie, School of Medicine Hannover, Germany.
Transpl Int. 1996;9(3):231-5. doi: 10.1007/BF00335391.
Patients with end-stage renal failure due to analgesic nephropathy have an increased risk of developing a urothelial carcinoma. To determine the impact of renal transplantation on the frequency of urothelial carcinomas, we analyzed 2072 patients who underwent 2371 renal transplantation between 1968 and 1993, including 78 (3.8%) with clinically proven analgesic nephropathy. Before and after transplantation a regular tumor screening was performed in patients with analgesic nephropathy by urine cytology and abdominal sonography. In 11 of the 78 patients with analgesic nephropathy (14.1%; age 51-66 years, 40-108 months after initiation of dialysis treatment, 5-77 months after transplantation), a urothelial carcinoma of the native urinary tract, especially the kidneys, was diagnosed. Therapy comprised nephroureterectomy (n = 6), transurethral resection (n = 6) and/or cystectomy (n = 2). Seven patients died due to tumor progression 16.3 (4-33) months postoperatively and one patient died due to a perioperative complication. Despite regular tumor screening after transplantation, the diagnosis of a urothelial carcinoma was made very late, leading to a high tumor-related mortality. As a consequence, we suggest that a bilateral nephroureterectomy should be performed prophylactically in patients with proven analgesic nephropathy. In addition, a cystoscopy with lavage cytology testing of the bladder should be performed twice a year.
镇痛药性肾病所致终末期肾衰竭患者发生尿路上皮癌的风险增加。为确定肾移植对尿路上皮癌发生频率的影响，我们分析了1968年至1993年间接受2371例肾移植的2072例患者，其中78例（3.8%）有临床确诊的镇痛药性肾病。对于镇痛药性肾病患者，在移植前后通过尿细胞学检查和腹部超声进行定期肿瘤筛查。在78例镇痛药性肾病患者中，有11例（14.1%；年龄51 - 66岁，开始透析治疗后40 - 108个月，移植后5 - 77个月）被诊断为原尿路尿路上皮癌，尤其是肾癌。治疗方法包括肾输尿管切除术（n = 6）、经尿道切除术（n = 6）和/或膀胱切除术（n = 2）。7例患者术后16.3（4 - 33）个月因肿瘤进展死亡，1例患者因围手术期并发症死亡。尽管移植后进行了定期肿瘤筛查，但尿路上皮癌的诊断仍很晚，导致肿瘤相关死亡率很高。因此，我们建议对确诊为镇痛药性肾病的患者预防性地进行双侧肾输尿管切除术。此外，应每年进行两次膀胱镜检查及膀胱灌洗细胞学检测。
