Conference paper
Urinary Tract Tumours in Areas with Endemic Nephropathy
Zoran Božić
; Liječnička ordinacija Kašinska 146
Abstract
The review describes the results of clinical-epidemiological studies of 58 patients with the upper urinary tract urothelioma (UUTU) and of 261 patients with the renal cell carcinoma (RCC) performed over a period of 11 and 1 2 y ears, respectiv ely. The subjects were domiciled in Croatia, Bosnia and Her zegovina, and the territory which now belongs to FR Yugoslavia. Some came from areas with endemic nephropathy. A comparison within groups clearly suggested a significantly marked epidemiological and clinical differences between the »endemic« and »nonendemic« UUTU and RCC patients. Different biological behaviour of the »endemic« UUTU, often accompanied by changes in renal parenchyma typical for endemic nephropathy, considerably changed the treatment results. An analysis of family and residential histories excluded the genetic basis and suggested environmental aetiology of the disease. There was a remarkable difference between the incidence of UUTU in patients from endemic areas, defined by living in affected households, and its incidence in patients living outside endemic areas. In some cases, the analysis of personal and family histories and of residence revealed the occurence of a complex clinical picture of chronic tubulointerstitial nephritis and UUTU in some patients and members of their households. Chronic renal failure caused by the lesion of renal parenchyma typical for endemic nephropathy was the principal complication in the treatment of »endemic« RCC and a usual noncarcinomatous cause of early and late postoperative mortality of patients. An analysis of personal and residential histories excluded the genetic basis and suggested environmental aetiology of the disease. As in UUTU patients, the difference between the incidence of RCC in patients from endemic areas and patients living outside endemic areas was remarkable. An analysis of personal and family histories and of residence revealed the occurence of a complex clinical picture of chronic tubulointerstitial nephritis and RCC in some patients and members of their households. The author traces the »endemic« UUTU and RCC to endemic nephropathy and merges them into one unique disease. The disease is considered as a single rural household environmental disease of the entire urinary tract due to shared dwelling and nourishment, without a precisely defined, but usually long latency. Clinical manifestations, including chronic renal failure due to the tubulointerstitial nephritis, renal cell carcinoma, and urotheliomas observed with a significantly higher incidence in the affected population, represent a complex and unique nosological entity.
Keywords
clinical characteristics; epidemiological characteristics; household environment; renal cell carcinoma; upper urinary tract urothelioma
Hrčak ID:
65679
URI
Publication date:
26.7.2000.
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