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Ureteral and renal pelvic tumors
Published in J Kellogg Parsons, E James Wright, The Brady Urology Manual, 2019
Risk factors are similar to bladder TCC and include:4SmokingAniline dyesAnalgesic abuse, especially phenacetin: often associated with more aggressive diseaseBalkan nephropathy: often bilateral and with multiple sitesChronic infection with calculi and obstruction (usually associated with SCC)Cyclophosphamide (and its metabolite, acrolein): often associated with more aggressive disease.
The urinary bladder
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Bladder cancer became a prescribed industrial disease (No. 39) in 1953, and previously exposed workers may be entitled to compensation. Balkan nephropathy is associated with an increased incidence of upper tract urothelial tumours (see Chapter 76).
General Biology of Cancer and Metastasis
Published in Anthony R. Mundy, John M. Fitzpatrick, David E. Neal, Nicholas J. R. George, The Scientific Basis of Urology, 2010
Common factors in most human cancers include damage to several genes (rather than one) resulting from point mutations, insertions, or deletions in certain genes known as oncogenes or tumor suppressor genes. Even recently, chemical causes of urothelial cancers have been shown to be important. Balkan nephropathy exists in certain defined parts of the Balkans. A herb found in these places, and also used widely in Chinese medicine, contains aristo-cholic acid and this chemical is nephrotoxic and carcinogenic.
Intracavitary therapies for upper tract urothelial carcinoma
Published in Expert Review of Clinical Pharmacology, 2018
John J. Knoedler, Jay D. Raman
Urothelial carcinoma of the upper tract represents only 5–10% of urothelial tumors, and as a rare disease there exists a paucity of high-level evidence on both diagnosis and management [1]. Up to 60% of upper tract tumors may be invasive at diagnosis, and the gold standard for high grade, bulky, or invasive upper tract urothelial carcinoma (UTUC) remains radical nephroureterectomy with an ipsilateral bladder cuff. However, elective and imperative indications for renal preservation exist. Patients electing for a conservative, organ-sparing approach ideally include those with low-risk disease, defined by the 2017 EAU guidelines as unifocal, small (<2 cm), low-grade by cytology and ureteroscopic biopsy, and without evidence of invasion on computed tomography [2]. However, imperative indications will exist for organ preservation despite the presence of high-risk disease. Imperative indications may include the presence of an anatomic or functionally solitary kidney, bilateral UTUC, comorbidities disqualifying from radical nephroureterectomy (RNU), chronic kidney disease, disease states representing a high risk of contralateral recurrence (i.e. Balkan Nephropathy, Lynch Syndrome), or patient refusal to undergo RNU.
Using herbs medically without knowing their composition: are we playing Russian roulette?
Published in Current Medical Research and Opinion, 2022
Orly F. Kohn, Susie Q. Lew, Steve Siu-Man Wong, Ramin Sam, Hung-Chun Chen, Jochen G. Raimann, David J. Leehey, Antonios H. Tzamaloukas, Todd S. Ing
The chronic use of herbs was associated with a 20% increased risk of developing chronic kidney disease in Taiwan. Specifically, the proportion of herbal users quantitatively correlated with the severity of renal failure16. More recently, aristolochic acid, from Aristolochia clematitis which grows mingled in the wheat fields of the Balkans was also found to be the long-sought cause of Balkan Nephropathy17. In addition, myriad other nephrotoxic herbs exist that can result in an array of kidney syndromes, including acute tubular necrosis, interstitial nephritis, proximal or distal tubulopathy, papillary necrosis, nephrolithiasis and urinary retention18,19.
A review on the pharmacological properties, toxicological characteristics, pathogenic mechanism and analytical methods of aristolochic acids
Published in Toxin Reviews, 2021
Miaomiao Zhang, Haiyan Liu, Yamei Han, Ligai Bai, Hongyuan Yan
AA is not only a nephrotoxin but also an urothelial carcinogen. Cosyns et al. (Cosyns et al. 1999) studied urothelial lesions of kidney disease with Chinese herbal medicine and concluded that the taking of Chinese herbal medicine containing AA was carcinogenic. To investigate the influence of AA on the human urothelial cells, Chang et al. (Chang et al. 2007) conducted a study with a mixture of AA (AAM; 41%AA-I, 56% AA-II). The results indicated that AAM induced cell cycle arrested in SV-HUC-1 cells. The clinical data of 39 patients with Chinese herbal medicine nephropathy by Nortier et al. (Nortier et al. 2000) confirmed that 46% patients with AA nephropathy developed urothelial carcinomas in the native kidneys. Moreover, all these patients were exposed to derivatives of Aristolochia species and found that the risk of urothelial carcinoma was associated with the cumulative dose of AA. Wang et al. reported that the risk of UUC increased when ingested more than 60 grams of Mu tong for people in Taiwan (Lai et al. 2010). Jelaković et al. (Jelaković et al. 2012) provided molecular epidemiologic evidence that dietary exposure to AA and TP53 mutational spectra was associated with UUC in endemic areas of Croatia, Serbia and Bosnia. The results indicated that dietary exposure to AA had a causal relationship with local (Balkan) nephropathy and UUC. To investigate the clinical and pathological features of AA-induced UUC, Chen et al. (Chen et al. 2013) compared the clinical or tumor results of AA-UUC and non-AA-UUC patients in Taiwan. The study concluded that exposure to AA had a risk of concurrent bilateral and metachronous contralateral UUC. Moreover, AA-UUC patients were mostly young women, and most of them were end stage renal disease. In 2013, Hollstein et al. (Hollstein et al. 2013) reviewed how modes of TP53 mutations in urothelial carcinomas of the upper urinary tract (UUT) patients from the Balkans and Taiwan differed from those in other cancers. A significant causal relationship between UUT and exposure to AA had been established by molecular epidemiological and experimental data.