Uroepithelial tumors of the renal pelvis associated with abuse of phenacetin-containing analgesics

This is a review of 62 patients with abuse of phenacetin-containing drugs and uroepithelial tumors of the renal pelvis. Most of the patients had a pre-existing nephropathy with papillary necrosis as a prominent feature. Fifty-six per cent of the patients have died, most of them from the tumor disease, but many were uremic at the time of death. Thus, the co-existing nephropathy contributed to the poor prognosis. The risk of overlooking an early tumor diagnosis is emphasized. Patients with a known nephropathy with papillary necrosis should be followed continuously, and even the finding of a discrete microscopic hematuria should prompt reinvestigation with radiologic examination of the kidneys. The diagnosis of a uroepithelial tumor of the renal pelvis should always lead to an analysis of the analgesic consumption, besides looking for occupational factors. On the basis of present knowledge of urinary tract carcinogens and phenacetin metabolites it is assumed that phenacetin is the crucial factor for the development of uroepithelial tumors in this study.