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Analgesic Nephropathy

By

Frank O'Brien

, MD, Washington University in St. Louis

Reviewed/Revised Jan 2024
View PATIENT EDUCATION

Analgesic nephropathy is chronic tubulointerstitial nephritis caused by cumulative lifetime use of large amounts (eg, 2 kg) of certain analgesics. Patients present with kidney injury and usually non-nephrotic proteinuria and bland urinary sediment or sterile pyuria. Hypertension, anemia, and impaired urinary concentration occur as renal insufficiency develops. Papillary necrosis occurs late. Diagnosis is based on a history of analgesic use and results of noncontrast CT. Treatment is stopping the causative analgesic.

Analgesic nephropathy, a type of chronic interstitial nephritis Chronic tubulointerstitial nephritis Tubulointerstitial nephritis is primary injury to renal tubules and interstitium resulting in decreased renal function. The acute form is most often due to allergic drug reactions or to infections... read more Chronic tubulointerstitial nephritis , was originally described in conjunction with overuse of combination analgesics containing phenacetin (typically with aspirin, acetaminophen, codeine, or caffeine). The incidence varied by region (eg, causing up to 10% of cases of end-stage kidney disease in Australia [ 1 References Analgesic nephropathy is chronic tubulointerstitial nephritis caused by cumulative lifetime use of large amounts (eg, ≥ 2 kg) of certain analgesics. Patients present with kidney injury and usually... read more ]), with a female predominance. Since the removal of phenacetin from the market, the incidence of analgesic nephropathy has declined (2 References Analgesic nephropathy is chronic tubulointerstitial nephritis caused by cumulative lifetime use of large amounts (eg, ≥ 2 kg) of certain analgesics. Patients present with kidney injury and usually... read more ). It remains uncertain whether non–phenacetin-containing combination analgesics, including acetaminophen, aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDs), are still implicated (3 References Analgesic nephropathy is chronic tubulointerstitial nephritis caused by cumulative lifetime use of large amounts (eg, ≥ 2 kg) of certain analgesics. Patients present with kidney injury and usually... read more ). Mechanism is unclear. However, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may cause acute tubulointerstitial nephritis Tubulointerstitial Nephritis Tubulointerstitial nephritis is primary injury to renal tubules and interstitium resulting in decreased renal function. The acute form is most often due to allergic drug reactions or to infections... read more Tubulointerstitial Nephritis or chronic kidney disease Chronic Kidney Disease Chronic kidney disease (CKD) is long-standing, progressive deterioration of renal function. Symptoms develop slowly and in advanced stages include anorexia, nausea, vomiting, stomatitis, dysgeusia... read more Chronic Kidney Disease .

References

  • 1. Chang SH, Mathew TH, McDonald SP: Analgesic nephropathy and renal replacement therapy in Australia: Trends, comorbidities and outcomes. Clin J Am Soc Nephrol 3(3):768-776, 2008. doi: 10.2215/CJN.04901107

  • 2. Mihatsch MJ, Khanlari B, Brunner FP: Obituary to analgesic nephropathy—An autopsy study. Nephrol Dial Transplant 21(11):3139-3145, 2006. doi: 10.1093/ndt/gfl390

  • 3. Feinstein AR, Heinemann LA, Curhan GC, et al: Relationship between nonphenacetin combined analgesics and nephropathy: A review. Ad Hoc Committee of the International Study Group on Analgesics and Nephropathy. Kidney Int 2000 58(6):2259-64. doi: 10.1046/j.1523-1755.2000.00410.x

Symptoms and Signs of Analgesic Nephropathy

Patients present with kidney injury and usually non-nephrotic proteinuria with a bland urinary sediment or sterile pyuria. Hypertension, anemia, and impaired urinary concentration are common once renal insufficiency develops.

Flank pain and hematuria and passage of a renal papilla (causing upper urinary tract obstruction) are signs of papillary necrosis that occur late in the course of disease.

Chronic complaints of musculoskeletal pain, headache, malaise, and dyspepsia may be related to long-term analgesic use rather than analgesic nephropathy.

Diagnosis of Analgesic Nephropathy

  • History of chronic analgesic use

  • CT

The diagnosis of analgesic nephropathy is based on history of chronic analgesic use and noncontrast CT. CT signs of analgesic nephropathy are the following:

  • Decreased renal size

  • Bumpy contours, defined as at least 3 indentations in the normally convex outline of the kidney

  • Papillary calcifications

The combination of these findings has a sensitivity of 87% and a specificity of 97% for early diagnosis (1 Diagnosis reference Analgesic nephropathy is chronic tubulointerstitial nephritis caused by cumulative lifetime use of large amounts (eg, ≥ 2 kg) of certain analgesics. Patients present with kidney injury and usually... read more ), but these specificity and sensitivity numbers are based on studies done when use of phenacetin-containing analgesics was widespread.

Diagnosis reference

Treatment of Analgesic Nephropathy

  • Stopping analgesic use

Renal function stabilizes when analgesics are stopped unless kidney injury is advanced, in which case it may progress to chronic kidney disease Chronic Kidney Disease Chronic kidney disease (CKD) is long-standing, progressive deterioration of renal function. Symptoms develop slowly and in advanced stages include anorexia, nausea, vomiting, stomatitis, dysgeusia... read more Chronic Kidney Disease . Patients with analgesic nephropathy are at greater risk of transitional cell carcinomas of the urinary tract.

Drugs Mentioned In This Article

Drug Name Select Trade
Anacin Adult Low Strength, Aspergum, Aspir-Low, Aspirtab , Aspir-Trin , Bayer Advanced Aspirin, Bayer Aspirin, Bayer Aspirin Extra Strength, Bayer Aspirin Plus, Bayer Aspirin Regimen, Bayer Children's Aspirin, Bayer Extra Strength, Bayer Extra Strength Plus, Bayer Genuine Aspirin, Bayer Low Dose Aspirin Regimen, Bayer Womens Aspirin , BeneHealth Aspirin, Bufferin, Bufferin Extra Strength, Bufferin Low Dose, DURLAZA, Easprin , Ecotrin, Ecotrin Low Strength, Genacote, Halfprin, MiniPrin, St. Joseph Adult Low Strength, St. Joseph Aspirin, VAZALORE, Zero Order Release Aspirin, ZORprin
7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Apra, Children's Acetaminophen, Children's Pain & Fever , Children's Pain Relief, Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody's Back & Body Pain, Infantaire, Infants' Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever , Pain and Fever , PAIN RELIEF , PAIN RELIEF Extra Strength, Panadol, PediaCare Children's Fever Reducer/Pain Reliever, PediaCare Children's Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant's Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children's, Tylenol Children's Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants', Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
No brand name available
Cafcit, NoDoz, Stay Awake, Vivarin
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