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  1. #1
    IMG SURVIVOR's Avatar
    IMG SURVIVOR is offline Moderator 536 points
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    #17 abuse abuse abuse of drugs

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    A 45 years old women with a long history of headaches develops microscopic hematuria and abnormal cytology


    tell me what is the DX?
    AND WHY?









    Transitional cell carcinoma
    abuse of analgesic
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    why even bother with the obvious. Just know where you are need it and where you can help the most.

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    is this related to NSAIDs and/or aspirin?

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    Most likely to Acetaminophen since it is hepto and renal toxic. Free radical damage. Now is the renal or bladder more subseptible to this toxicity?
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    acetaminophen is more toxic to the liver... especially to the zone 3 area where it gets the less oxygen; whereas aspirin is more toxic to the kidneys.. believe it's the peritubular area (but can't remember...); is an accumulative effect

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    I thought aspirin knocked off PGE2 allowing Ant II to cause VC. I did not think it had any toxic effect to the point of causing cancer.
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    I thought aspirin knocked off PGE2 allowing Ant II to cause VC. I did not think it had any toxic effect to the point of causing cancer
    I looked at this question.. I didn't understand the cancer concept and wanted to remember the area that ASA affected the kidneys....

    As stated, Acetaminophen and ASA both affect the liver and kidney; Acetaminophen converts to free radicals around zone 3 where there is less oxygen, leading to fulminant hepatitis; ASA also causes fulminant hepatitis; ASA damages the inner mitochondria membrane releasing heat and not ATP; In regards to kidney, Acetaminophen damages the renal medulla, more specifically the renal papillary leading to necrosis whereas ASA inhibits the PGE2 (vasodilator) leaving angiotensin II in control of the blood flow in the kidneys (a vasoconstrictor!!) thereby losing the ability to dilute/concentrate the urine; All of these changes occurs due to an accumulative effect.. with the combination leading to analgesic nephropathy;

    Now, let's look at the question...
    lady has had chronic headaches, takes analgesics (most common is ASA and/or Acetaminophen)--irritants to the liver and kidney, slowly sloughing of the renal papillary, lead to dysplasia probably from hyperplasia (cause could be from chronic irritants), and can be a transitional state leading to cancer... If the irritants are stopped, then the process is stopped from going to cancer, and it remains dysplasia.

    Had to work backwards on this question... please post if there is any other information that could be helpful... thank you.

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