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Murray FJ, Monnot AD, Jacobson-Kram D, Cohen SM, Hardisty JF, Bandara SB, Kovochich M, Deore M, Pitchaiyan SK, Gelotte CK, Lai JCK, Atillasoy E, Hermanowski-Vosatka A, Kuffner E, Unice KM, Yang K, Gebremichael Y, Howell BA, Eichenbaum G. A critical review of the acetaminophen preclinical carcinogenicity and tumor promotion data and their implications for its carcinogenic hazard potential. Regul Toxicol Pharmacol 2020; 118:104801. [PMID: 33039518 DOI: 10.1016/j.yrtph.2020.104801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/11/2020] [Accepted: 10/06/2020] [Indexed: 12/22/2022]
Abstract
In 2019 the California Office of Environmental Health Hazard Assessment (OEHHA) initiated a review of the carcinogenic hazard potential of acetaminophen, including an assessment of the long-term rodent carcinogenicity and tumor initiation/promotion studies. The objective of the analysis herein was to inform this review process with a weight-of-evidence assessment of these studies and an assessment of the relevance of these models to humans. In most of the 14 studies, there were no increases in the incidences of tumors in any organ system. In the few studies in which an increase in tumor incidence was observed, there were factors such as absence of a dose response and a rodent-specific tumor supporting that these findings are not relevant to human hazard identification. In addition, we performed qualitative analysis and quantitative simulations of the exposures to acetaminophen and its metabolites and its toxicity profile; the data support that the rodent models are toxicologically relevant to humans. The preclinical carcinogenicity results are consistent with the broader weight of evidence assessment and evaluations of multiple international health authorities supporting that acetaminophen is not a carcinogenic hazard.
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Affiliation(s)
| | | | | | - Samuel M Cohen
- Havlik-Wall Professor of Oncology, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
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- DILIsym Services Inc., Research Triangle Park, NC, USA
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Abstract
Chronic kidney disease (CKD) and cancer are connected in a number of ways in both directions: cancer can cause CKD either directly or indirectly through the adverse effects of therapies; CKD may, conversely, be a risk factor for cancer; and both may be associated because they share common risk factors, often toxins. In this review, we briefly address the issue of paraneoplastic nephropathies as well as that of toxin-related cancers and CKD, including analgesic and aristolochic acid nephropathies. We then focus on the links between the various stages of CKD and cancer incidence, and critically examine major epidemiologic surveys in the field. Compared with the general population, kidney transplant recipients have a threefold to fourfold increase in overall cancer risk, and relative risks higher than 3 for about 20 specific tumors, most, but not all, of which are known or suspected to be caused by viral agents. After dialysis, cancer risk increases 10% to 80% according to studies, with relative risks significantly higher than in the general population, for about 10 cancer sites. There is emerging evidence for an excess risk of cancer in patients in early CKD stages.
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Affiliation(s)
- Benedicte Stengel
- Inserm, CESP Centre for Research in Epidemiology and Population Health, U1018, Epidemiology of Diabetes, Obesity and Chronic Kidney Disease over the lifecourse, Université Paris Sud 11, UMRS 1018, Villejuif cedex - France.
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Henrich WL, Clark RL, Kelly JP, Buckalew VM, Fenves A, Finn WF, Shapiro JI, Kimmel PL, Eggers P, Agodoa LE, Porter GA, Shapiro S, Toto R, Anderson T, Cupples LA, Kaufman DW. Non-contrast-enhanced computerized tomography and analgesic-related kidney disease: report of the national analgesic nephropathy study. J Am Soc Nephrol 2006; 17:1472-80. [PMID: 16611714 DOI: 10.1681/asn.2005101096] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Previous studies suggested that the non-contrast-enhanced computerized tomography (CT) scan is a highly reliable tool for the diagnosis of analgesic-associated renal disease. However, this issue has not been addressed in the US population. A total of 221 incident patients with ESRD from different regions of the United States underwent a helical CT scan and detailed questioning about drug history. Specific renal anatomic criteria were developed to determine whether a constellation of CT findings (small indented calcified kidneys [SICK]) is linked to analgesic ingestion. For approximating use before the onset of renal disease, only analgesic ingestion at least 9 yr before starting dialysis was considered relevant. Fifteen patients met the criteria for SICK. This represented 7% of the enrolled patients and approximately 1% of the total ESRD population. There was a significant increase in the estimated risk among patients with a history of heavy aspirin ingestion (odds ratio [OR] 7.4 [95% confidence interval (CI) 1.2 to 43] for > or =1 kg lifetime; OR 8.8 [95% CI 1.2 to 66] for > or =0.3 kg/yr). Total analgesic ingestion of > or =0.3 kg/yr also was significantly associated with SICK (OR 8.2; 95% CI 1.5 to 45). These findings were accounted for largely by combination products that contained aspirin and phenacetin (used by three patients with SICK), which are no longer available. In addition, the CT finding of SICK was present only in a minority of heavy analgesic users, yielding a sensitivity of 5 to 26%. Findings of SICK are infrequent in the US ESRD population and do not occur among a sufficient proportion of heavy analgesic users to render the non-contrast-enhanced CT scan a sensitive tool to detect analgesic-associated kidney injury.
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Affiliation(s)
- William L Henrich
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Kankuri E, Solatunturi E, Vapaatalo H. Effects of phenacetin and its metabolite p-phenetidine on COX-1 and COX-2 activities and expression in vitro. Thromb Res 2003; 110:299-303. [PMID: 14592552 DOI: 10.1016/s0049-3848(03)00416-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The present study was aimed to test the possible cyclooxygenase (COX)-1/COX-2 selectivity of the old analgesic drug phenacetin and its metabolite p-phenetidine, which exhibits high renal toxicity. Paracetamol (acetaminophen), the main metabolite of phenacetin with low renal toxicity, and indomethacin were selected as reference compounds. Collagen-stimulated platelet thromboxane B2 (TxB2) production and phorbol 12-myristate-13-acetate (PMA)-induced neutrophil prostaglandin E2 (PGE2) synthesis were used as indicators for COX-1 and COX-2 activity, respectively. Phenacetin was even less potent than paracetamol to reduce the production of both TxB2 and PGE2, and no clear preference for either of the COX-enzymes was seen. P-phenetidine was a more potent inhibitor, already at nanomolar level, of the synthesis of these prostanoids than indomethacin and showed some preference to COX-2 inhibition. Somewhat higher, micromolar, concentrations of p-phenetidine also reduced COX-2 expression in neutrophils. We suggest that the very potent inhibitory activity of p-phenetidine on PGE2 synthesis combined with the reduction of COX-2 expression could explain the renal papillary necrosis in phenacetin kidney.
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Affiliation(s)
- Esko Kankuri
- Institute of Biomedicine, Pharmacology, University of Helsinki, Biomedicum, PO Box 63, 00014 University of Helsinki, Helsinki, Finland
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Affiliation(s)
- C G Newstead
- Renal Unit, St James's University Hospital, Leeds, UK
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Lee CC, Wanibuchi H, Yamamoto S, Hirose M, Hayashi Y, Fukushima S. Molecular cytogenetic identification of cyclin D1 gene amplification in a renal pelvic tumor attributed to phenacetin abuse. Pathol Int 1999; 49:648-52. [PMID: 10504527 DOI: 10.1046/j.1440-1827.1999.00902.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Despite extensive epidemiologic evidence of phenacetin abuse as a risk factor for renal pelvic carcinomas, genetic alterations in the resultant tumors remain largely unclear. In this report, a phenacetin-associated renal pelvic carcinoma (histologically a transitional-cell carcinoma) from an 80-year-old female patient was evaluated by molecular cytogenetic methods. Fluorescence in situ hybridization was used to identify chromosome gains or losses for the cyclin D1, p53, Rb and c-myc genes and the ploidy of their respective chromosomes. Cyclin D1 gene amplification, but normal copy numbers of p53, Rb and c-myc, and normal ploidy of chromosomes 8, 11, 13 and 17 were observed. Expression of cyclin D1 protein was confirmed by immunohistochemistry. In the absence of p53, Rb or c-myc abnormalities, the results suggested that cyclin D1 gene amplification and its protein overexpression may be involved in the genesis of renal pelvic carcinomas associated with phenacetin abuse.
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MESH Headings
- Aged
- Aged, 80 and over
- Analgesics, Non-Narcotic/adverse effects
- Carcinoma, Transitional Cell/chemically induced
- Carcinoma, Transitional Cell/genetics
- Carcinoma, Transitional Cell/pathology
- Chromosomes, Human/genetics
- Cyclin D1/analysis
- Fatal Outcome
- Female
- Genes, Retinoblastoma/genetics
- Genes, bcl-1/genetics
- Genes, myc/genetics
- Genes, p53/genetics
- Humans
- Immunoenzyme Techniques
- In Situ Hybridization, Fluorescence
- Kidney Neoplasms/chemically induced
- Kidney Neoplasms/genetics
- Kidney Neoplasms/pathology
- Kidney Pelvis/drug effects
- Kidney Pelvis/pathology
- Phenacetin/adverse effects
- Ploidies
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Affiliation(s)
- C C Lee
- First Department of Pathology, Osaka City University Medical School, Nagoya, Japan
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Shalat SL, True LD, Fleming LE, Pace PE. Kidney cancer in utility workers exposed to polychlorinated biphenyls (PCBs). BRITISH JOURNAL OF INDUSTRIAL MEDICINE 1989; 46:823-824. [PMID: 2511925 PMCID: PMC1009876 DOI: 10.1136/oem.46.11.823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- S L Shalat
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06510
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Steffens J, Nagel R. Tumours of the renal pelvis and ureter. Observations in 170 patients. BRITISH JOURNAL OF UROLOGY 1988; 61:277-83. [PMID: 3289673 DOI: 10.1111/j.1464-410x.1988.tb13957.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A study was made of 170 patients with renal pelvis or ureteric tumours, 160 of whom underwent surgery between 1948 and 1981. The most important aetiological factor was chronic phenacetin abuse: 21.7% of 83 patients with renal pelvis tumours and 11.4% of those with ureteric tumours gave a history of phenacetin abuse. The latency periods ranged from 24 to 26 years. This is the first report of a relationship between abuse of analgesics and urothelial tumours from the Federal Republic of Germany.
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Affiliation(s)
- J Steffens
- Department of Urology, Free University of Berlin, Charlottenburg Hospital, West Germany
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Dunn TL, Gardiner RA, Seymour GJ, Lavin MF. Genotoxicity of analgesic compounds assessed by an in vitro micronucleus assay. Mutat Res 1987; 189:299-306. [PMID: 3670333 DOI: 10.1016/0165-1218(87)90061-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Several analgesic compounds and mixtures of analgesics were examined for both cytotoxicity and ability to induce chromosomal damage in the normal rat-kidney cell line NRK-49F. Chromosomal damage was assessed using an in vitro micronucleus assay. Of all the compounds tested, only N-hydroxyparacetamol caused a high degree of cell death at the concentrations used. 4 analgesic compounds were found to be inducers of micronuclei in NRK cells; in order of decreasing potency these were: N-hydroxyparacetamol, N-hydroxyphenacetin, caffeine and paracetamol. An aspirin, phenacetin, caffeine mixture (APC) failed to induce micronuclei above the background level, and a paracetamol-codeine combination did not increase the level of micronuclei induction above that induced by paracetamol alone. This report suggests paracetamol and some related compounds are capable of inducing chromosomal damage in mammalian cells in vitro, which is consistent with recent reports of a possible paracetamol-DNA interaction.
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Affiliation(s)
- T L Dunn
- Department of Biochemistry, University of Queensland, Brisbane, Australia
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Abstract
Although the question of whether or not analgesic abuse leads to a certain type of nephropathy has been investigated since 1953, no conclusive answer has been forthcoming. Epidemiologic investigations on the correlation between analgesic abuse and renal function as well as experimental animal studies have given contradictory results concerning the possibility of analgesic-associated kidney damage. However, studies on the correlation between analgesic abuse and papillary necrosis have demonstrated that this lesion coincides in 69% of the cases with an analgesic history. Follow-up studies of patients with analgesic nephropathy have shown that renal function deteriorates in 60% of the patients with continued abuse and that it stabilizes in 80% of the patients after cessation of abuse. Studies on the legislative restriction of phenacetin/acetaminophen, carried out mostly in Scandinavian countries since 1965, show a 50%-90% decline in signs of analgesic nephropathy (papillary necrosis) following a reduction in the sale of these drugs. The prevalence of analgesic abuse may be underestimated, since up to 80% of the abusers tend to deny their analgesic intake. Obviously, only a small percentage of analgesic abusers (approximately 1%) finally develop nephropathy. Even though the results of epidemiologic and experimental studies are contradictory, the results of investigations on papillary necrosis and on legislative prevention as well as of patient follow-ups tend to indicate a correlation between analgesic abuse and a well-defined type of nephropathy.
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Bach PH, Bridges JW. Chemically induced renal papillary necrosis and upper urothelial carcinoma. Part 1. Crit Rev Toxicol 1985; 15:217-329. [PMID: 3933914 DOI: 10.3109/10408448509089854] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the past, renal papillary necrosis (RPN) has been commonly associated with long-term abusive analgesic intake, but over recent years a wide variety of industrially and therapeutically used chemicals have been shown to induce this lesion experimentally or in man. Destruction of the renal papilla may result in: (1) secondary degenerative cortical changes which precede chronic renal failure or (2) a rapidly metastasizing upper urothelial carcinoma, which has a very poor prognosis. This article will briefly review the published data on the morphology, function, and biochemistry of the normal renal medulla and the pathology associated with RPN, together with the secondary changes which give rise to cortical degeneration or epithelial carcinoma. It will then examine in detail those chemicals which have been reported to cause RPN in an attempt to delineate structure-activity relationships. Finally, the many different theories that have been proposed to explain the pathophysiology of RPN will be examined and an hypothesis will be put forward to explain the primary pathogenesis of the lesion and its secondary consequences.
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Bach PH, Bridges JW. Chemically induced renal papillary necrosis and upper urothelial carcinoma. Part 2. CRC CRITICAL REVIEWS IN TOXICOLOGY 1985; 15:331-441. [PMID: 3935375 DOI: 10.3109/10408448509056267] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the past, renal papillary necrosis (RPN) has been commonly associated with long-term abusive analgesic intake, but over recent years a wide variety of industrially and therapeutically used chemicals have been shown to induce this lesion experimentally or in man. Destruction of the renal papilla may result in: (1) secondary degenerative cortical changes which precede chronic renal failure or (2) a rapidly metastasizing upper urothelial carcinoma, which has a very poor prognosis. This article will briefly review the published data on the morphology, function, and biochemistry of the normal renal medulla and the pathology associated with RPN, together with the secondary changes which give rise to cortical degeneration or epithelial carcinoma. It will then examine in detail those chemicals which have been reported to cause RPN in an attempt to delineate structure-activity relationships. Finally, the many different theories that have been proposed to explain the pathophysiology of RPN will be examined and an hypothesis will be put forward to explain the primary pathogenesis of the lesion and its secondary consequences.
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Raghavan D, Pearson B, Coorey G, Arnold D, Smith J, Donovan J, Langdon P, Woods W. Intravenous cis‐platinum for invasive bladder cancer. Med J Aust 1984. [DOI: 10.5694/j.1326-5377.1984.tb104036.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Derek Raghavan
- Urological Cancer Research UnitRoyal Prince Alfred HospitalCamperdownNSW2050
| | - Bruce Pearson
- Urological Cancer Research UnitRoyal Prince Alfred HospitalCamperdownNSW2050
| | - Glen Coorey
- Urological Cancer Research UnitRoyal Prince Alfred HospitalCamperdownNSW2050
| | - Dennis Arnold
- Urological Cancer Research UnitRoyal Prince Alfred HospitalCamperdownNSW2050
| | - John Smith
- Urological Cancer Research UnitRoyal Prince Alfred HospitalCamperdownNSW2050
| | - John Donovan
- Urological Cancer Research UnitRoyal Prince Alfred HospitalCamperdownNSW2050
| | - Peter Langdon
- Urological Cancer Research UnitRoyal Prince Alfred HospitalCamperdownNSW2050
| | - William Woods
- Radiotherapy and Oncology CentreSydney Adventist HospitalWahroongaNSW2076
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Abstract
Most antipyretic analgesics can cause acute nephrotoxic effects, including acute tubular necrosis, acute interstitial nephritis, glomerular toxicity, and functional changes, such as "salicyl edema," following large doses of sodium salicylate. Most functional changes are related to acute suppression of prostaglandin synthesis, "the acute prostaglandin-effect," and have been primarily noted with the use of indomethacin. The association between prolonged and excessive consumption of compound analgesics and the development of renal disease and renal failure, characterized by renal papillary necrosis, is now well established. Studies in several countries have shown that the incidence of analgesic nephropathy as an indication for dialysis and transplantation corresponds to the per capita consumption of phenacetin in compound analgesics. Analgesic nephropathy, which is part of a wider clinical syndrome, the analgesic syndrome, is uncommon following the use of single analgesics. Analgesic nephropathy and the analgesic syndrome are discussed in detail, including the development of uroepithelial tumors.
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Taylor JS. Malignant tumours of the kidney. Med J Aust 1983; 1:604. [PMID: 6855679 DOI: 10.5694/j.1326-5377.1983.tb136245.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Birkeland SA. Chronic antigenic stimulation from the graft as a possible oncogenic factor after renal transplant. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1983; 17:355-9. [PMID: 6359387 DOI: 10.3109/00365598309182145] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In the period 1956-1976, 3 649 kidney transplantations were performed on 3 040 patients in Scandinavia. In the same period 67 primary malignant tumours were detected in these patients. In comparisons using age and sex-specific incidence in a background population, the observed tumour incidence was significantly higher than expected. Analyses were made in regard to a number of factors with potential influence on oncogenesis. The interval from transplantation to appearance of tumour was significantly longer in the recipients of grafts from living relatives than in cadaver kidney recipients. Significant correlation of tumour incidence was found with HLA mismatch in recipients of necrokidneys. Chronic interstitial nephritis as underlying kidney disease and blood transfusion showed correlation with tumour incidence. From these observations the hypothesis is proposed that a chronic antigen effect is a dominant factor among the numerous possible oncogenic mechanisms in patients with transplants.
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Abstract
A lifetime history of analgesics and tobacco consumption was obtained by a questionnaire completed at interview from 67 patients with carcinoma of the renal pelvis (40 women, 27 men) and 180 control subjects drawn from two sources, friends of patients and persons attending a health screening clinic. Regular consumption of analgesics conferred a tenfold relative risk of renal pelvic cancer in women and in men a risk ratio of 4-8. The fraction of cases for which analgesic consumption was an attributable risk was 0.74 in women and 0.43 in men. The effect of tobacco, much less than that of analgesics, was significant only in women (risk ratio approximately four; attributable risk 0.4), and no dose-response relationship was demonstrated. Relative excess risks suggested a synergistic effect when both analgesics and tobacco had been consumed. Standardized risk ratios indicated a dose-response relationship for both phenacetin-containing and non-phenacetin analgesics: moderate consumption doubled the risk of renal pelvic cancer, and heavy consumption increased at risk to 6-16 times that for noncomsumers.
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Hayward NK, Lavin MF, Craswell PW. Inhibition of DNA synthesis and alteration to DNA structure by the phenacetin analog p-aminophenol. Biochem Pharmacol 1982; 31:1425-9. [PMID: 7092931 DOI: 10.1016/0006-2952(82)90038-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
p-Aminophenol a structural analog and minor metabolite of phenacetin has previously been shown to be a potent nephrotoxic agent. In this report we have shown that p-aminophenol has a marked effect on DNA function and structure. DNA synthesis was inhibited in a dose-dependent manner in human lymphoblastoid cells after exposure to p-aminophenol. Results suggest that DNA synthesis is inhibited by the action of p-aminophenol on DNA structure. At low concentrations of p-aminophenol a reduction in the degree of supercoiling of cellular DNA is observed, as determined by sedimentation under neutral conditions. However at higher concentrations an increase in sedimentation of nucleoids (supercoiled molecules) is obtained which is indicative of an increased level of supercoiling or a more compact structural form of DNA due to folding or aggregation. The number of single strand breaks in DNA, when determined by sedimentation in alkaline sucrose gradients, increases with increasing dose of p-aminophenol. The increase in strand breakage observed at lower concentrations of p-aminophenol agrees with the reduced sedimentation rate obtained under neutral conditions. At higher concentrations of p-aminophenol the extent of breakage of DNA increases under alkaline conditions but an increase in sedimentation occurs under neutral conditions.
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Cove-Smith JR. Analgesic nephropathy in the United Kingdom: Incidence, clinical features and pathogenesis. J Clin Pathol 1981; 34:1255-60. [PMID: 7320222 PMCID: PMC494477 DOI: 10.1136/jcp.34.11.1255] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Macklin AW, Szot RJ. Eighteen month oral study of aspirin, phenacetin and caffeine, in C57Bl/6 mice. Drug Chem Toxicol 1980; 3:135-63. [PMID: 7227215 DOI: 10.3109/01480548009108279] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Groups of 40 male and 40 female C57BL/6 mice were maintained for 75-80 weeks on meal form diets containing aspirin, phenacetin and caffeine either singly or in combination. The maximum daily doses of phenacetin alone and the APC combination were approximately one-half of their previously determined respective oral LD50's. Mild, nonprogressive histopathologic changes of the urinary tract were noted with these changes first evident in animals given the highest dose of phenacetin. Sulfhemoglobinemia was also induced in all groups of animals given phenacetin alone or in combination indicating that toxic doses were administered oral LD50's. Mild, nonprogressive histopathologic changes of the urinary tract were noted with these changes first evident in animals given the highest dose of phenacetin. Sulfhemoglobinemia was also induced in all groups of animals given phenacetin alone or in combination indicating that toxic doses were administered oral LD50's. Mild, nonprogressive histopathologic changes of the urinary tract were noted with these changes first evident in animals given the highest dose of phenacetin. Sulfhemoglobinemia was also induced in all groups of animals given phenacetin alone or in combination indicating that toxic doses were administered. Under the conditions of this study, evidence of carcinogens was not demonstrated for any of the drugs given alone or in combination.
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Abstract
1 Analgesic nephropathy is part of the analgesic syndrome which has gastrointestinal, haematological, cardiovascular, psychological and psychiatric, and pregnancy and gonadal manifestations; premature ageing may also be a feature. 2 Analgesic nephropathy is a form of renal disease characterized by renal papillary necrosis, secondary chronic interstitial nephritis and renal failure with features of predominant tubulointerstitial dysfunction. 3 The percentage of patients with analgesic nephropathy who present with terminal renal failure is 12%. With appropriate management, 17% of analgesic nephropathy patients improve, 50% remain stable and 23% deteriorate. The 6 year cumulative survival is 70%. The major factors influencing deterioration are malignant hypertension, persistent proteinuria and small initial renal size. 4 The risk of renal papillary carcinoma in patients who regularly take analgesics is 8 per 100,000 patients per year. 5 Renal papillary necrosis is a consequence of the chronic toxicity of all non-steroidal anti-inflammatory drugs and results from medullary ischaemia secondary to suppression of prostaglandin E2 synthesis and from direct cellular toxicity. 6 Analgesic nephropathy is a preventable form of renal disease and renal failure. It can be prevented by limiting the abuse potential of analgesics rather than by making minor modifications in the composition of analgesic mixtures.
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Abstract
In the Hunter Valley, New South Wales, the incidence of renal pelvic carcinoma was found to be very high, and there appeared to be a causal relationship with analgesic abuse. The crude incidence rate was calculated at 1.6/100000 population per year. In half of the cases of renal pelvic carcinoma, there was evidence of analgesic abuse and/or analgesic nephropathy with papillary necrosis; in this group the male/female ratio was 1/2.6, and there was a tendency for the cancers to occur at a younger age. Tumours associated with analgesic nephropathy were more often poorly differentiated and in a more advanced stage at the time of diagnosis than those not associated with analgesic nephropathy. Multiple tumours were equally common in both groups, but coexistent flat carcinoma in situ tended to be more common in cases associated with analgesic nephropathy.
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Abstract
A case of localized ureteric stricture in a woman with analgesic nephropathy is reported. The problems of diagnosis and management are briefly discussed.
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Jackson B, Kirkland JA, Lawrence JR, Narayan AS, Brown HE, Mills LR. Urine cytology findings in analgesic nephropathy. J Urol 1978; 120:145-7. [PMID: 671620 DOI: 10.1016/s0022-5347(17)57081-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Urine cytology screening for neoplasm led to the detection of 3 urothelial carcinomas and 1 severe urothelial dysplasia in 98 patients with analgesic-induced papillary necrosis. A further 18 patients had changes suggesting that they were at risk of incurring malignancy in the near future. Routine urine cytology is recommended in all cases of analgesic nephropathy.
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Nanra RS, Stuart-Taylor J, de Leon AH, White KH. Analgesic nephropathy: etiology, clinical syndrome, and clinicopathologic correlations in Australia. Kidney Int 1978; 13:79-92. [PMID: 362034 DOI: 10.1038/ki.1978.11] [Citation(s) in RCA: 99] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Analgesic abuse is a major public health hazard in Australia, and analgesic nephropathy with consequent terminal renal failure is the underlying cause in 20% of the patients requiring dialysis and transplantation. Analgesics are invariably taken in the form of compounds and mixtures. In the aspirin-phenacetin-caffeine (APC) mixture, aspirin appears to be the major nephrotoxic agent and phenacetin appears to play a secondary and synergistic role. The renal disease associated with abuse of analgesics is characteristic and is part of a much wider clinical syndrome, the analgesic syndrome, which includes peptic ulcer disease (35%), anemia (60 to 90%), hypertension (15 to 70%), ischemic heart disease (35%), psychological and psychiatric manifestations, pigmentation, and possible gonadal- and pregnancy-related effects. The primary lesion in analgesic nephropathy is renal papillary necrosis (RPN), and this is a nephrotoxic effect common to all nonsteroid antiinflammatory agents. The most important factor in the management of patients with analgesic nephropathy is the cessation of analgesic abuse, and this leads to improvement and stabilization of renal function. A small proportion of patients will, however, deteriorate in relation to accelerated hypertension, persistent proteinuria, ischemic heart disease, and complications leading to nephrectomy. Patients with analgesic nephropathy are poor risk patients and have a poor prognosis, even after dialysis and transplantation.
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Bengtsson U, Johansson S, Angervall L. Malignancies of the urinary tract and their relation to analgesic abuse. Kidney Int 1978; 13:107-13. [PMID: 713263 DOI: 10.1038/ki.1978.13] [Citation(s) in RCA: 78] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A relationship between analgesic abuse and urothelial renal pelvic tumors was first observed in 1965. Since then more than 100 cases of such tumors have been reported in abusers of phenacetin-containing drugs; most of these cases have been from Sweden. Many patients had a preexisting nephropathy with renal papillary necrosis. The total consumption of the drugs could be estimated to several kilograms, and the average period of consumption was 17 yr in the Göteborg study. The manifest development of the tumor often came a few years after the cessation of the drug abuse. The clinical picture and the pathologic findings are described and the five-year survival rate is given. Multiple tumors in the urinary tract were common. Carcinogenic factors are discussed. Phenacetin is an aromatic amide with N-hydroxylated metabolites, closely related to known carcinogenic amines like the naphthylamines which earlier caused occupational bladder cancer. Furthermore, the data on exposition (consumption) time and tumor induction time were very similar in occupational bladder cancer and in renal pelvic cancer related to analgesic abuse. Animal experiments of long-term phenacetin feeding have produced a high degree of papillary epithelial hyperplasia. Further investigations are under way.
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Mahony JF, Storey BG, Ibañez RC, Stewart JH. Analgesic abuse, renal parenchymal disease and carcinoma of the kidney or ureter. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1977; 7:463-9. [PMID: 272165 DOI: 10.1111/j.1445-5994.1977.tb03366.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In a consecutive series of 88 cases of carcinoma of the kidney and upper urinary tract seen at one hospital, 31 had malignant urothelial tumours of the renal pelvis or ureter. Forty-two per cent of these transitional-cell carcinomas occurred in patients with renal papillary necrosis following upon prolonged and heavy analgesic ingestion. Other possible aetiological factors were heavy cigarette smoking (61% of cases), long standing urinary obstruction or infection (23%) and possible occupational exposure (6%); in only four cases (13%) was there no identifiable aetiological factor. Those cases with analgesic nephropathy were characterised by renal functional impairment, hypertension and interstitial nephritis, but there was no difference in the clinical behaviour or pathological appearances of the tumours in the two groups. The clinical and experimental evidence that certain metabolites of phenacetin are carcinogenic is reviewed.
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Abstract
A case-control study among 574 male and 158 female bladder cancer patients and equal numbers of matched controls was conducted between 1969 and 1974 in 17 hospitals in six United States cities. We determined that cigarette smokers of both sexes were at higher relative risk than nonsmokers. Cigarette smoking was responsible for about one-half of male and one-third of female bladder cancer. There was an excess of bladder cancer patients with some previous occupational exposure, such as rubber, chemicals, and textiles. A weak association with coffee drinking, which appeared to be independent of smoking, was found for males. Users of artificial sweeteners were not over-represented among the cases. The authors conclude that the epidemiologic pattern of bladder cancer cannot be fully accounted for by cigarette smoking and occupational exposure and suggest a series of metabolic studies to assess the role of additional factors, such as nutrition.
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Stewart JH, Gallery ED. Analgesic abuse and kidney disease. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1976; 6:498-508. [PMID: 1071883 DOI: 10.1111/j.1445-5994.1976.tb03045.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The analgesic syndrome, comprising renal disease, hypertension, peptic ulcer, anaemia and recurrent headache, accounts for wide-spread morbidity and mortality especially in Queensland and New South Wales. Epidemiological and clinical evidence gathered from many Western societies implicates unsupervised consumption of compound analgesic preparations, particularly those containing phenacetin, in the causation of the majority of cases. Laboratory experiments so far have failed to produce an entirely satisfactory model of clinical analgesic nephropathy. In small animals, papillary necrosis results from prolonged feeding with large doses of aspirin and a number of other anti-inflammatory agents more readily than when phenacetin, paracetamol or phenazone is given alone. The apparently conflicting deductive and experimental data may be reconciled if, as indicated by preliminary observations, salicylates enhance the toxicity of phenacetin derivatives. In planning a programme of prevention for the analgesic syndrome, the central aetiological role of non-narcotic drug dependency must be recognized. As the analgesics to which addiction commonly occurs are the compound powders and tablets, or those containing a stimulant, these preparations should be available only in circumstances where their use can be monitored. Suspected unsupervised and unwarranted consumption of analgesics should be checked by urinary testing for drug metabolites. Because the underlying problem of analgesic dependency is behavioural and environmental in origin rather than medical, the physician must combine forces with the social engineer to devise a definitive solution for this condition.
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Armstrong B, Garrod A, Doll R. A retrospective study of renal cancer with special reference to coffee and animal protein consumption. Br J Cancer 1976; 33:127-36. [PMID: 944046 PMCID: PMC2024935 DOI: 10.1038/bjc.1976.17] [Citation(s) in RCA: 66] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Interviews were obtained with 106 patients with adenocarcinoma of the renal parenchyma, 33 patients with carcinoma of the renal pelvis and 139 individually matched control patients. Comparison of the cancer patients with the control patients showed no evidence of a positive association between either type of renal cancer and coffee or animal protein consumption. Carcinoma of the renal pelvis was associated positively with cigareete consumption (relative risk estimate 1-8) and the daily consumption of analgesic tablets was more frequent in patients with cancer of the renal parenchyma than in their matched controls (14-2% compared with 1-9%,P less than 0.005). It appeared likely that the latter relationship was non-causal.
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