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Management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The proper management is:

  • remove the offending drug
  • treat any urinary tract infection, management of hypertension, avoid dehydration (which may precipitate papillary necrosis)

This may result in stabilization or slight improvement of the renal function.

If chronic renal failure ensues then this should be treated accordingly.

Urothelial malignancy is a late complication of analgesic abuse.

  • screening is not effective in the detection of early urothelial tumours (1).
    • therefore prophylactic nephroureterectomy should be considered in patients with end-stage renal failure, especially in those who have received renal transplants (2)
    • long-term comparative outcomes of open versus laparoscopic nephroureterectomy for upper urinary tract urothelial-cell carcinoma are similar

Reference:

  • Prescribers' Journal 2000; 40 (2): 151-156.
  • Kliem V et al. High mortality from urothelial carcinoma despite regular screening in patients with analgesic nephropathy after renal transplantation. Transpl Int 1996; 9:231-5.
  • Stewart GD, Humphries KJ, Cutress ML, Riddick AC, McNeill SA, Tolley DA. Long-term comparative outcomes of open versus laparoscopic nephroureterectomy for upper urinary tract urothelial-cell carcinoma after a median follow-up of 13 years. J Endourol. 2011;25:1329-35

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