HIGH MORTALITY FROM UROTHELIAL CARCINOMA DESPITE REGULAR TUMOR SCREENING IN PATIENTS WITH ANALGESIC NEPHROPATHY AFTER RENAL-TRANSPLANTATION

Patients with end-stage renal failure due to analgesic nephropathy hav e an increased risk of developing a urothelial carcinoma. To determine the impact of renal transplantation on the frequency of urothelial ca rcinomas, we analyzed 2072 patients who underwent 2371 renal transplan tations between 1968 and 1993, including 78 (3.8%) with clinically pro ven analgesic nephropathy. Before and after transplantation a regular tumor screening was performed in patients with analgesic nephropathy b y urine cytology and abdominal sonography. In 11 of the 78 patients wi th 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 kid neys, was diagnosed. Therapy comprised nephroureterectomy (n = 6), tra nsurethral 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 c arcinoma was made very late, leading to a high tumor-related mortality . As a consequence, we suggest that a bilateral nephroureterectomy sho uld be performed prophylactically in patients with proven analgesic ne phropathy. In addition, a cystoscopy with lavage cytology testing of t he bladder should be performed twice a year.