DE-NOVO UROTHELIAL CARCINOMA OF THE UPPER AND LOWER URINARY-TRACT IN KIDNEY - TRANSPLANT PATIENTS WITH END-STAGE ANALGESIC NEPHROPATHY

Patients with end-stage analgesic nephropathy bear a higher risk for u rothelial cancer than do patients with other renal diseases. In a retr ospective study in patients with analgesic nephropathy and kidney tran splants we analyzed the prevalence and clinical course of de novo urot helial cancer. Diagnosis of analgesic nephropathy was based on the pat ients' history and clinical data. Only patients under cyclosporine tre atment were included. Between 1968 and 1993, 2,371 kidney transplants were performed on 2,072 patients in the Department of Abdominal and Tr ansplant Surgery. The prevalence of analgesic nephropathy was 3.1%. Of 65 patients with analgesic nephropathy and kidney transplants, 10 (15 .4%) developed urothelial carcinoma; 10.8%, bladder cancer; and 9.1%, renal pelvic cancer. The mean age at diagnosis was 56.1 years. Urothel ial cancer occurred on average at 33.6 months posttransplantation. On average, 6 of 10 patients with urothelial cancer died of the disease a t 16.9 months after the diagnosis. All patients with urothelial bladde r cancer had a muscle-infiltrating tumor of moderate or high grade. Si nce urothelial renal pelvic cancer occurred in 9.1% of our patients wi th analgesic nephropathy and urological screening is insufficient in p atients on dialysis, we suggest that prophylactic nephroureterectomy b e performed on one side before transplantation and on the contralatera l side at 3-6 months after transplantation. An aggressive approach is indicated in patients with urothelial cancer of the bladder.