Analgesic Abuse, Renal Parenchymal Disease and Carcinoma of the Kidney or Ureter

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Abstract
In a series of 88 cases of carcinoma of the kidney and upper urinary tract seen at 1 hospital, 31 had malignant urothelial tumors of the renal pelvis or ureter. Forty-two percent of these transitional cell carcinomas occurred in patients with renal papillary necrosis following prolonged and heavy analgesic ingestion. Other possible etiological factors were heavy cigarette smoking (61% of cases), long standing urinary obstruction or infection (23%) and possible occupational exposure (6%). In only 4 cases (13%) was there no identifiable etiological factor. Those cases with analgesic nephropathy were characterized by renal functional impairment, hypertension and interstitial nephritis, but there was no difference in the clinical behavior or pathological appearances of the tumors in the 2 groups. The clinical and experimental evidence that certain metabolites of phenacetin are carcinogenic is reviewed.