ABSTRACT
Following a report by Hultengren et al. (Acta Chir Scand, 1965), it has been suggested that analgesic abuse predisposes to urothelial neoplasia. Urinary tract malignancy is combined in 8-10% of patients with analgesic nephropathy. Microscopic or gross hematuria can be the first sign leading to the diagnosis of uroepithelial malignanacy in analgesic abusers. Since uroepithelial malignancies found in analgesic abusers tend to be multiple and have a worse prognosis, continued monitoring is essential, and new hematuria should be evaluated with urinary cytology, and cystoscopy with reterograde pyelography. Phenacetin found to be the chief cause of malignancies in analgesic abusers, it has been anticipated to be a human carcinogen and was banned as an OTC drug since 1987. But still there remains a debate whether acetaminophen and other compound analgesic components are carcinogenic. We report the case of a 58-year-old man with a history of analgesic abuse who was diagnosed with transitional cell carcinoma combined with analgesic nephropathy. We also review the literature.
Subject(s)
Humans , Middle Aged , Acetaminophen , Analgesics , Carcinoma, Transitional Cell , Cystoscopy , Diagnosis , Hematuria , Nephritis, Interstitial , Phenacetin , Prognosis , Ureter , Urinary Tract , UrographyABSTRACT
A 45-year-old woman was admitted with proteinuria, hematuria and intermittent generalized edema. On admission, hypertension, chronic B-viral hepatitis were evident together with a decreased renal function. Light and electron microscopy revealed diffuse and nodular glomerulosclerosis indistinguishable from diabetic nodular glomerulosclerosis. Diabetes mellitus, however, had been excluded both by extensive clinical and by laboratory investigation. The differential diagnosis also included primary and secondary membranoproliferative glomerulonephritis, thrombotic microangiopathy, amyloidosis, monoclonal immunoglobulin deposition disease, fibrillary glomerolonephritis, immunotactoid glomerulopathy, light chain deposition disease. However, these entities could be excluded by immunohistochemistry and ultrastructural investigations. We report a case of idiopathic nodular glomerulosclerosis, which has not been previously reported in the Korean literature.
Subject(s)
Female , Humans , Middle Aged , Amyloidosis , Diabetes Mellitus , Diabetic Nephropathies , Diagnosis, Differential , Edema , Glomerulonephritis, Membranoproliferative , Hematuria , Hepatitis , Hypertension , Immunoglobulins , Immunohistochemistry , Microscopy, Electron , Proteinuria , Thrombotic MicroangiopathiesABSTRACT
Primary aldosteronism is a disease entity characterized by hypertension, hypokalemia, metabolic alkalosis and muscle weakness. Aldosteronoma is the most common cause of primary aldosteronism. The prevalence of primary aldosteronism in patients with hypertension appears to be low, less than 1%. However, primary aldosteronism is the one of common cause of secondary hypertension that is one of a few potentially curable forms of hypertension by surgical treament. The malignant hypertension in primary aldosteronism is very rare and the renal vascular damage due to hypertension seldom occurs. There has been no known reports about primary aldosteronism complicated with chronic renal failure in Korea. We report the rare case of primary aldosteronism in patient with hypokalemia, metabolic alkalosis complicated with chronic renal failure due to malignant hypertension with evident nephrosclerosis.