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Monique Elseviers - One of the best experts on this subject based on the ideXlab platform.

  • Analgesic Nephropathy: is it caused by multi-Analgesic abuse or single substance use?
    Drug safety, 1999
    Co-Authors: Monique Elseviers, M. E. De Broe
    Abstract:

    Analgesic Nephropathy is a slowly progressive renal disease, characterised by renal papillary necrosis. Recently, diagnostic criteria for this disease have been defined based on renal computed tomography scanning performed without contrast. The observation of a decreased renal mass of both kidneys, combined with either bumpy contours or papillary calcifications, has been found to have high diagnostic specificity and sensitivity. However, the question remains as to what kind of Analgesics can cause Analgesic Nephropathy. In the majority of early reports about this condition, phenacetin was singled out as the nephrotoxic culprit. However, during the last decade the nephrotoxic potential of nonphenacetin-containing preparations has become apparent. It is clear that people who abuse Analgesics prefer combination Analgesics containing 2 Analgesics combined with caffeine and/or codeine. In contrast, abuse of products containing only aspirin (acetylsalicylic acid) or paracetamol (acetaminophen) is seldom described and associated renal disease is only occasionally reported. Experimental evidence of the nephrotoxicity of Analgesic preparations is not well established. The results of studies involving Analgesic administration in animals remain contradictory. Clinical evidence linking high consumption of Analgesic preparations with Analgesic Nephropathy is overwhelming. Most patients who admit to over-consuming Analgesics have taken preparation containing more than one compound. In recent years, it has become more apparent that preparations not containing phenacetin also have the potential to cause nephrotoxicity manifesting as identical renal lesions. Further epidemiological evidence of the nephrotoxic potential of Analgesic combinations has come from case-control studies published during the last decade and from 2 prospective cohort studies. Effective prevention of Analgesic Nephropathy consists of the prohibition of over-the-counter sales of preparation containing at least 2 Analgesics associated with caffeine and/or codeine.

  • incidence of Analgesic Nephropathy among patients undergoing renal replacement therapy in czech republic and slovak republic
    Nephrology Dialysis Transplantation, 1996
    Co-Authors: K Matousovic, Monique Elseviers, D Devecka, M Horackova, T Turek, M. E. De Broe
    Abstract:

    Background. The occurrence of Analgesic Nephropathy (AN) among renal replacement therapy patients in former Czechoslovakia is not known. Previous surveys were not based on representative samples and lacked uniform criteria for diagnosing the disease. Methods. Incidence of AN in former Czechoslovakia was investigated in patients commencing renal replacement therapy in 24 (1/3 of all) dialysis centres from 1 January to 31 December 1992. Patients showing an unclear renal diagnosis (« = 149) were investigated with an interview and renal imaging techniques. The diagnosis of AN was withheld or rejected on the base of recently published diagnostic criteria demonstrating that a decreased renal mass of both kidneys combined with bumpy contours and/or papillary calcifications had a high performance for diagnosing AN (Nephrol Dial Transplant 1992; 7: 479-486). Results. Based on the renal imaging criteria, AN was diagnosed in 30 of 328 registered patients, resulting in an AN incidence of 9.1% while the EDTA data only mentioned an incidence of 4.8% (period 1986-1989). The products most commonly abused were Analgesic mixtures containing two Analgesic substances combined with caffeine and/or codeine. Conclusions. AN was found to be a common disease in the Czech and Slovak Republics. The disease was diagnosed using reliable renal imaging criteria.

  • Combination Analgesic involvement in the pathogenesis of Analgesic Nephropathy: the European perspective.
    American Journal of Kidney Diseases, 1996
    Co-Authors: Monique Elseviers, M. E. De Broe
    Abstract:

    Analgesic Nephropathy (AN) is a chronic renal disease characterized by renal papillary necrosis and interstitial nephritis caused by excessive consumption of Analgesic mixtures. In a recent study, diagnostic criteria for AN, based on a computed tomography scan investigation without contrast, were presented. The observation of a decreased renal mass of both kidneys combined with either bumpy contours or papillary calcifications was found to have a high diagnostic performance. Although several case control studies and two prospective studies demonstrated the association between Analgesic abuse and Nephropathy, the nephrotoxicity of the different Analgesic products had not been clearly established. Analgesic abuse can be defined as a daily consumption of Analgesic mixtures over a several-year period. Abuse of single Analgesics is rare; it has been clearly demonstrated that abusers prefer Analgesic mixtures. In Belgium, the prevalence of AN was positively related to the sales of Analgesic mixtures containing two Analgesic components plus caffeine and/or codeine. This relationship could not be observed for Analgesics containing only one Analgesic component plus caffeine and/or codeine. Moreover, during a European multicenter study, nephrotoxicity of different combinations of Analgesic mixtures (all containing caffeine and/or codeine) could be documented in the absence of any previous phenacetin consumption. Epidemiologic observations in Sweden, France, and Belgium regarding incidence of AN, sales figures of Analgesics, and legislative measurements concerning Analgesic consumption supported the previous observations.

  • high diagnostic performance of ct scan for Analgesic Nephropathy in patients with incipient to severe renal failure
    Kidney International, 1995
    Co-Authors: Monique Elseviers, Arthur De Schepper, Robert Corthouts, Jeanlouis Bosmans, Luc Cosyn, R L Lins, W Lornoy, Erve Matthys, Rik Roose, Danny Van Caesbroeck
    Abstract:

    High diagnostic performance of CT scan for Analgesic Nephropathy in patients with incipient to severe renal failure. Recently, well performing diagnostic criteria for Analgesic Nephropathy in end-stage renal failure (ESRF) patients were defined by the demonstration of a bilateral decrease in renal volume combined with either bumpy contours or papillary calcifications. In this study, the diagnostic value of computed tomography (CT) scan was compared to the previously used renal imaging techniques (sonography and conventional tomography). In a first study, a cohort of 40 Analgesic abusers (defined as daily use of Analgesic mixtures during at least 5 years) and 40 controls, all ESRF patients without a clear renal diagnosis, were investigated with sonography, tomography and CT scan without injection of iodinated contrast material, to search for the imaging signs of Analgesic Nephropathy. Using CT scan, sonography and tomography, renal size could be evaluated with comparable results while CT scan was superior in the detection of papillary calcifications (sensitivity 87%, specificity 97%). In a second controlled study of 53 Analgesic abusers with a serum creatinine between 1.5 to 4 mg/dl in the absence of a clear renal diagnosis, a CT scan was performed and scored for the presence of decreased renal volume, bumpy contours and papillary calcifications. It was found that the renal image of Analgesic Nephropathy on CT scan in an early stage of renal failure is comparable with the observations made in ESRF patients. Particularly the demonstration of papillary calcifications showed a high sensitivity of 92% with a specificity of 100% for the early diagnosis of Analgesic Nephropathy.

  • evaluation of diagnostic criteria for Analgesic Nephropathy in patients with end stage renal failure results of the anne study
    Nephrology Dialysis Transplantation, 1995
    Co-Authors: Monique Elseviers, Anke Schwarz, I Waller, D Nenov, J Levora, K Matousovic, T Tanquerel, Wolfgang Pommer, E Keller, H Thieler
    Abstract:

    It was found that in Belgium, renal imaging techniques, demonstrating a decreased renal mass of both kidneys combined with either bumpy contours or papillary calcifications, were the only methods to reliably diagnose Analgesic Nephropathy (AN) in patients with end-stage renal failure. However, these criteria were selected in an area with a high prevalence of this disease (15.6% of the dialysis population at December 1990). To evaluate the criteria selected to diagnose AN in populations with lower or unknown prevalences of AN, the Analgesic Nephropathy Network of Europe (ANNE) was formed, consisting of 23 dialysis units from 14 European countries and Brazil. During 1991-1992, 598 new patients with equivocal diagnosis of renal disease (excluding biopsy-proven glomerulonephritis, polycystic disease, diabetic Nephropathy and other systemic diseases) and who began renal replacement therapy in the ANNE centres were evaluated by a short questionnaire and two renal imaging techniques : sonography and either tomography or computed tomography (CT) scan. A comparison of 82 abusers (daily use of Analgesic mixtures for at least 5 years) and 495 controls corroborated the excellent diagnostic performance of the renal imaging techniques for AN. We recommend the use of these renal imaging criteria in all patients without a clear renal diagnosis in order to obtain a more reliable insight into the magnitude of the AN problem in different countries.

Anke Schwarz - One of the best experts on this subject based on the ideXlab platform.

  • incidence of Analgesic Nephropathy in berlin since 1983
    Nephrology Dialysis Transplantation, 1999
    Co-Authors: Anke Schwarz, Lothar Preuschof, Dietmar Zellner
    Abstract:

    Background. Phenacetin was removed from the German market in 1986 and was replaced mainly in Analgesic compounds by acetaminophen. Our objective was to examine the effect of this measure on the incidence of Analgesic Nephropathy in light of the changes in other end-stage renal diseases. Methods. We therefore compared the proportion of renal diseases in all patients starting dialysis treatment during three 18-month periods: 4/1982-9/1983 (n= 57); 1/1991-6/1992 (n=81); and 10/1995 3/1997 (n =76). Results. On the one hand, the proportion of end-stage Analgesic Nephropathy decreased significantly from 30% in 1981-1982 to 21% in 1991-1992 and 12% in 1995-1997 (P=0.01). On the other hand, type II diabetes increased significantly from 7% to 22% (P=0.01) and 29% (P=0.001). Using the X 2 distribution test to analyze the frequencies of seven diseases at three different time intervals, however, showed that the changes in renal-disease proportions between 1982-1983, 1991-1992 and 1995- 1997 were not significantly independent. There was a significant median age increase from 52 years (CI 0.95 44-58) in 1982-1983 to 63 (CI 0.95 55-67) in 1991-1992 and 63 (CI 0.95 60-66) in 1995-1997 (P=0.003) for all patients starting dialysis but not for those with Analgesic Nephropathy [59(55-71) vs 64(53-67) and 61 (50-72); n.s.]. Conclusion. The decrease of end-stage Analgesic Nephropathy since 1983 may be partially due to the removal of phenacetin from the German market in 1986. However, considering the general increase in numbers of dialysis patients, their higher age and the increased incidence of type II diabetes, the decrease in Analgesic Nephropathy is not a statistically significant independent variable. Altered admittance policies for dialysis treatment have yielded a new pattern of renal-disease proportion which interferes with changes in the incidence of Analgesic Nephropathy.

  • evaluation of diagnostic criteria for Analgesic Nephropathy in patients with end stage renal failure results of the anne study
    Nephrology Dialysis Transplantation, 1995
    Co-Authors: Monique Elseviers, Anke Schwarz, I Waller, D Nenov, J Levora, K Matousovic, T Tanquerel, Wolfgang Pommer, E Keller, H Thieler
    Abstract:

    It was found that in Belgium, renal imaging techniques, demonstrating a decreased renal mass of both kidneys combined with either bumpy contours or papillary calcifications, were the only methods to reliably diagnose Analgesic Nephropathy (AN) in patients with end-stage renal failure. However, these criteria were selected in an area with a high prevalence of this disease (15.6% of the dialysis population at December 1990). To evaluate the criteria selected to diagnose AN in populations with lower or unknown prevalences of AN, the Analgesic Nephropathy Network of Europe (ANNE) was formed, consisting of 23 dialysis units from 14 European countries and Brazil. During 1991-1992, 598 new patients with equivocal diagnosis of renal disease (excluding biopsy-proven glomerulonephritis, polycystic disease, diabetic Nephropathy and other systemic diseases) and who began renal replacement therapy in the ANNE centres were evaluated by a short questionnaire and two renal imaging techniques : sonography and either tomography or computed tomography (CT) scan. A comparison of 82 abusers (daily use of Analgesic mixtures for at least 5 years) and 495 controls corroborated the excellent diagnostic performance of the renal imaging techniques for AN. We recommend the use of these renal imaging criteria in all patients without a clear renal diagnosis in order to obtain a more reliable insight into the magnitude of the AN problem in different countries.

  • Analgesic Nephropathy and renal transplantation
    Nephrology Dialysis Transplantation, 1992
    Co-Authors: Anke Schwarz, G Offermann, F Keller
    Abstract:

    Analgesic Nephropathy was the most frequent diagnosis in 324 haemodialysis patients (30%) and the second most frequent diagnosis in 900 transplant patients (17%) at the Klinikum Steglitz, Berlin. Analgesic patients were the oldest group among haemodialysis and transplanted patients; the Analgesic patients on haemodialysis were significantly older than the transplanted Analgesic patients (55.9 +/- 11.2 versus 50.5 +/- 7.5 years, P = 10(-6)). Patient and graft survival under cyclosporin treatment are not statistically different in 125 transplantations of 109 patients with Analgesic Nephropathy compared to 508 transplantations of 423 patients with other renal diseases (5-year patient survival, 83.3 +/- 5.1% versus 88.4 +/- 2.4%; 5-year graft survival, 53.5 +/- 7.4% versus 56.8 +/- 3.8%; NS). Acetaminophen in urine was found in two of 30 Analgesic and in one of 54 other patients with a functioning transplant (6.7% versus 1.9%; NS). As a sign of compliance, the mean cyclosporin trough level of 17 patients with Analgesic Nephropathy did not differ significantly from that of 14 patients with polycystic kidney disease (136.4 +/- 16.4 versus 139.4 +/- 17.3 ng/ml; NS), nor did the mean standard deviation of the individual measurements (36.7 +/- 36.8 versus 27.5 +/- 20.7 ng/ml; NS). Urothelial carcinoma was significantly more frequent in patients with Analgesic Nephropathy than in those with other renal diseases despite cystoscopy and retrograde pyelography before transplantation (3.7% versus 0.32%; P = 0.001). Vascular disease was the cause of death in 19 of 44 Analgesic transplant patients who died (43.2%).(ABSTRACT TRUNCATED AT 250 WORDS)

M. E. De Broe - One of the best experts on this subject based on the ideXlab platform.

  • Analgesic Nephropathy: is it caused by multi-Analgesic abuse or single substance use?
    Drug safety, 1999
    Co-Authors: Monique Elseviers, M. E. De Broe
    Abstract:

    Analgesic Nephropathy is a slowly progressive renal disease, characterised by renal papillary necrosis. Recently, diagnostic criteria for this disease have been defined based on renal computed tomography scanning performed without contrast. The observation of a decreased renal mass of both kidneys, combined with either bumpy contours or papillary calcifications, has been found to have high diagnostic specificity and sensitivity. However, the question remains as to what kind of Analgesics can cause Analgesic Nephropathy. In the majority of early reports about this condition, phenacetin was singled out as the nephrotoxic culprit. However, during the last decade the nephrotoxic potential of nonphenacetin-containing preparations has become apparent. It is clear that people who abuse Analgesics prefer combination Analgesics containing 2 Analgesics combined with caffeine and/or codeine. In contrast, abuse of products containing only aspirin (acetylsalicylic acid) or paracetamol (acetaminophen) is seldom described and associated renal disease is only occasionally reported. Experimental evidence of the nephrotoxicity of Analgesic preparations is not well established. The results of studies involving Analgesic administration in animals remain contradictory. Clinical evidence linking high consumption of Analgesic preparations with Analgesic Nephropathy is overwhelming. Most patients who admit to over-consuming Analgesics have taken preparation containing more than one compound. In recent years, it has become more apparent that preparations not containing phenacetin also have the potential to cause nephrotoxicity manifesting as identical renal lesions. Further epidemiological evidence of the nephrotoxic potential of Analgesic combinations has come from case-control studies published during the last decade and from 2 prospective cohort studies. Effective prevention of Analgesic Nephropathy consists of the prohibition of over-the-counter sales of preparation containing at least 2 Analgesics associated with caffeine and/or codeine.

  • incidence of Analgesic Nephropathy among patients undergoing renal replacement therapy in czech republic and slovak republic
    Nephrology Dialysis Transplantation, 1996
    Co-Authors: K Matousovic, Monique Elseviers, D Devecka, M Horackova, T Turek, M. E. De Broe
    Abstract:

    Background. The occurrence of Analgesic Nephropathy (AN) among renal replacement therapy patients in former Czechoslovakia is not known. Previous surveys were not based on representative samples and lacked uniform criteria for diagnosing the disease. Methods. Incidence of AN in former Czechoslovakia was investigated in patients commencing renal replacement therapy in 24 (1/3 of all) dialysis centres from 1 January to 31 December 1992. Patients showing an unclear renal diagnosis (« = 149) were investigated with an interview and renal imaging techniques. The diagnosis of AN was withheld or rejected on the base of recently published diagnostic criteria demonstrating that a decreased renal mass of both kidneys combined with bumpy contours and/or papillary calcifications had a high performance for diagnosing AN (Nephrol Dial Transplant 1992; 7: 479-486). Results. Based on the renal imaging criteria, AN was diagnosed in 30 of 328 registered patients, resulting in an AN incidence of 9.1% while the EDTA data only mentioned an incidence of 4.8% (period 1986-1989). The products most commonly abused were Analgesic mixtures containing two Analgesic substances combined with caffeine and/or codeine. Conclusions. AN was found to be a common disease in the Czech and Slovak Republics. The disease was diagnosed using reliable renal imaging criteria.

  • Combination Analgesic involvement in the pathogenesis of Analgesic Nephropathy: the European perspective.
    American Journal of Kidney Diseases, 1996
    Co-Authors: Monique Elseviers, M. E. De Broe
    Abstract:

    Analgesic Nephropathy (AN) is a chronic renal disease characterized by renal papillary necrosis and interstitial nephritis caused by excessive consumption of Analgesic mixtures. In a recent study, diagnostic criteria for AN, based on a computed tomography scan investigation without contrast, were presented. The observation of a decreased renal mass of both kidneys combined with either bumpy contours or papillary calcifications was found to have a high diagnostic performance. Although several case control studies and two prospective studies demonstrated the association between Analgesic abuse and Nephropathy, the nephrotoxicity of the different Analgesic products had not been clearly established. Analgesic abuse can be defined as a daily consumption of Analgesic mixtures over a several-year period. Abuse of single Analgesics is rare; it has been clearly demonstrated that abusers prefer Analgesic mixtures. In Belgium, the prevalence of AN was positively related to the sales of Analgesic mixtures containing two Analgesic components plus caffeine and/or codeine. This relationship could not be observed for Analgesics containing only one Analgesic component plus caffeine and/or codeine. Moreover, during a European multicenter study, nephrotoxicity of different combinations of Analgesic mixtures (all containing caffeine and/or codeine) could be documented in the absence of any previous phenacetin consumption. Epidemiologic observations in Sweden, France, and Belgium regarding incidence of AN, sales figures of Analgesics, and legislative measurements concerning Analgesic consumption supported the previous observations.

  • impact of legislative measures on the sales of Analgesics and the subsequent prevalence of Analgesic Nephropathy a comparative study in france sweden and belgium
    Nephrology Dialysis Transplantation, 1995
    Co-Authors: L M Noels, Monique Elseviers, M. E. De Broe
    Abstract:

    Abstract In a number of European countries (e.g. Belgium), Analgesic Nephropathy continues to be a highly prevalent renal disease, whereas in other countries (e.g. Sweden) the problem has been resolved after legislative measures were taken. In still other countries, e.g. France, the official prevalence of Analgesic Nephropathy has always been low. The aim of the present study is to detect whether specific legislation in particular countries has played a role in the prevalence of Analgesic Nephropathy. Hence, we compared Analgesic legislation in Belgium, France and Sweden, and then compared it with the respective sales data of non-narcotic Analgesics and with the prevalence data of Analgesic Nephropathy in the dialysis population. Each investigated country represents a different evolution pattern in the prevalence of Analgesic Nephropathy. This study indicates that legislation restricting the over-the-counter availability of the majority of Analgesic components and resulting in the absence of Analgesic mixtures--containing two Analgesic substances and one potentially addictive substance--on the market, has effectively resulted in a substantially lower prevalence of Analgesic Nephropathy. Moreover, it shows that permissive legislation could be associated with very different sales data, depending on the marketing strategy of the pharmaceutical industry and the subsequent purchasing behaviour of the population. These findings indicate that, in order to eradicate Analgesic Nephropathy, there is a need to elaborate legislation that prohibits the availability of Analgesic mixtures containing two Analgesic components and at least one potentially addictive substance.

  • Analgesic Nephropathy in Belgium is related to the sales of particular Analgesic mixtures
    Nephrology dialysis transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 1994
    Co-Authors: Monique Elseviers, M. E. De Broe
    Abstract:

    Analgesic Nephropathy, a chronic progressive renal disease induced by the abuse of drugs containing Analgesics and potentially addictive substances (e.g. caffeine, codeine), continues to be a serious problem in Belgium. A recent investigation (1990) of Belgian dialysis patients, including 54 of the 55 dialysis centres, established that 15.6% of the patients had Analgesic Nephropathy, showing a small decrease in prevalence compared to the 1979 and 1984 estimates. Considerable changes were observed in the sales figures of Analgesic during the period 1983-1991. Phenacetin completely disappeared from the market and single Analgesics, particularly paracetamol, gained large market shares. The total sales of single Analgesics slowly increased, whereas the sales of Analgesic mixtures decreased from 12.5 million to 8 million packages per year. In recent years the composition of most Analgesic mixtures has been reduced to a single Analgesic component in combination with caffeine and/or codeine. In comparing the geographical distribution of the sales of different Analgesic products (1983) with the prevalence of Analgesic Nephropathy (1990), a strong correlation could be observed with particular Analgesic mixtures, whereas this was not the case with single Analgesics. This observation suggests that a careful analysis of sales data showing a high volume of Analgesic mixtures sold, containing two Analgesic substances combined with potentially addictive components, is a pharmacoepidemiological indicator for the presence of Analgesic Nephropathy in a given population.

R Brunkhorst - One of the best experts on this subject based on the ideXlab platform.

  • high mortality from urothelial carcinoma despite regular tumor screening in patients with Analgesic Nephropathy after renal transplantation
    Transplant International, 1996
    Co-Authors: Volker Kliem, Walter Thon, Steffen Krautzig, Martin Kolditz, Matthias Behrend, R Pichlmayr, Karl M Koch, Ulrich Frei, R Brunkhorst
    Abstract:

    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 transplantations 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.

  • denovo urothelial carcinoma of the upper and lower urinary tract in kidney transplant patients with end stage Analgesic Nephropathy
    World Journal of Urology, 1995
    Co-Authors: Walter F Thon, Volker Kliem, Michael C Truss, P Anton, Markus A Kuczyk, C G Stief, R Brunkhorst
    Abstract:

    Patients with end-stage Analgesic Nephropathy bear a higher risk for urothelial cancer than do patients with other renal diseases. In a retrospective study in patients with Analgesic Nephropathy and kidney transplants we analyzed the prevalence and clinical course of de novo urothelial cancer. Diagnosis of Analgesic Nephropathy was based on the patients' history and clinical data. Only patients under cyclosporine treatment were included. Between 1968 and 1993, 2,371 kidney transplants were performed on 2,072 patients in the Department of Abdominal and Transplant 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. Urothelial cancer occurred on average at 33.6 months posttransplantation. On average, 6 of 10 patients with urothelial cancer died of the disease at 16.9 months after the diagnosis. All patients with urothelial bladder cancer had a muscle-infiltrating tumor of moderate or high grade. Since urothelial renal pelvic cancer occurred in 9.1% of our patients with Analgesic Nephropathy and urological screening is insufficient in patients on dialysis, we suggest that prophylactic nephroureterectomy be performed on one side before transplantation and on the contralateral side at 3–6 months after transplantation. An aggressive approach is indicated in patients with urothelial cancer of the bladder.

Rik Roose - One of the best experts on this subject based on the ideXlab platform.

  • high diagnostic performance of ct scan for Analgesic Nephropathy in patients with incipient to severe renal failure
    Kidney International, 1995
    Co-Authors: Monique Elseviers, Arthur De Schepper, Robert Corthouts, Jeanlouis Bosmans, Luc Cosyn, R L Lins, W Lornoy, Erve Matthys, Rik Roose, Danny Van Caesbroeck
    Abstract:

    High diagnostic performance of CT scan for Analgesic Nephropathy in patients with incipient to severe renal failure. Recently, well performing diagnostic criteria for Analgesic Nephropathy in end-stage renal failure (ESRF) patients were defined by the demonstration of a bilateral decrease in renal volume combined with either bumpy contours or papillary calcifications. In this study, the diagnostic value of computed tomography (CT) scan was compared to the previously used renal imaging techniques (sonography and conventional tomography). In a first study, a cohort of 40 Analgesic abusers (defined as daily use of Analgesic mixtures during at least 5 years) and 40 controls, all ESRF patients without a clear renal diagnosis, were investigated with sonography, tomography and CT scan without injection of iodinated contrast material, to search for the imaging signs of Analgesic Nephropathy. Using CT scan, sonography and tomography, renal size could be evaluated with comparable results while CT scan was superior in the detection of papillary calcifications (sensitivity 87%, specificity 97%). In a second controlled study of 53 Analgesic abusers with a serum creatinine between 1.5 to 4 mg/dl in the absence of a clear renal diagnosis, a CT scan was performed and scored for the presence of decreased renal volume, bumpy contours and papillary calcifications. It was found that the renal image of Analgesic Nephropathy on CT scan in an early stage of renal failure is comparable with the observations made in ESRF patients. Particularly the demonstration of papillary calcifications showed a high sensitivity of 92% with a specificity of 100% for the early diagnosis of Analgesic Nephropathy.

  • diagnostic criteria of Analgesic Nephropathy in patients with end stage renal failure results of the belgian study
    Nephrology Dialysis Transplantation, 1992
    Co-Authors: Monique Elseviers, R L Lins, W Lornoy, Erve Matthys, V Bosteels, P Cambier, M De Paepe, J P Godon, C Moeremans, Rik Roose
    Abstract:

    Diagnostic criteria of Analgesic Nephropathy with well-defined sensitivity and specificity are not available. During a 2-year period all new patients (n = 273) starting renal replacement therapy in 13 Belgian dialysis units were investigated aiming to select diagnostic criteria of Analgesic Nephropathy with acceptable performance. Using several interview techniques, a history of Analgesic abuse was found in 31% of the patients. Analgesic abusers presenting a clear non-Analgesic-related renal diagnosis were excluded from analysis (n = 25). Comparing the remaining abusers (n = 60) and patients without a history of Analgesic abuse (n = 188) it was found that renal imaging investigations (sonography plus tomography), showing a decrease in length combined with bumpy contours of both kidneys, presented a sensitivity of 90% and a specificity of 95%. The additional finding of signs of renal papillary necrosis resulted in an overall sensitivity of 72% and a specificity of 97%, giving a positive predictive value of 92%. Other signs frequently mentioned in the literature (hypertension, anaemia, sterile pyuria, bacteriuria, proteinuria) showed insufficient sensitivity and/or specificity to be of help for diagnosing Analgesic Nephropathy in end-stage renal failure (ESRF) patients starting renal replacement therapy.