Analgesic nephropathy

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC

Analgesic nephropathy
Phenacetin, a compound associated with analgesic nephropathy
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Chronic kidney disease, hypertension, anemia, urinary tract infection
Complications	End-stage renal disease, cardiovascular disease
Onset	Long-term use of analgesics
Duration	Chronic
Types	N/A
Causes	Prolonged use of analgesics such as phenacetin, aspirin, and acetaminophen
Risks	High-dose and long-term use of analgesics, especially combinations
Diagnosis	Urinalysis, blood tests, imaging studies
Differential diagnosis	Chronic interstitial nephritis, pyelonephritis, glomerulonephritis
Prevention	Avoidance of excessive analgesic use
Treatment	Discontinuation of offending analgesics, management of chronic kidney disease
Medication	N/A
Prognosis	Variable; may lead to end-stage renal disease if not addressed
Frequency	Decreasing due to reduced use of phenacetin
Deaths	N/A

Analgesic nephropathy is a form of chronic kidney disease caused by the long-term use of analgesic medications, particularly those containing phenacetin, aspirin, and acetaminophen. This condition is characterized by damage to the small filtering units in the kidneys, known as nephrons, leading to progressive renal impairment.

Pathophysiology

The pathophysiology of analgesic nephropathy involves the accumulation of toxic metabolites from analgesics in the renal medulla. These metabolites cause renal papillary necrosis and chronic interstitial nephritis. The condition is often associated with the formation of renal calculi and can lead to chronic kidney disease and end-stage renal disease.

Risk Factors

Several risk factors contribute to the development of analgesic nephropathy, including:

• Prolonged use of analgesics, especially in combination.
• High cumulative doses of analgesics.
• Pre-existing renal impairment.
• Dehydration and reduced renal perfusion.

Clinical Presentation

Patients with analgesic nephropathy may present with:

• Hypertension
• Hematuria
• Proteinuria
• Flank pain
• Symptoms of chronic kidney disease, such as fatigue and edema.

Diagnosis

The diagnosis of analgesic nephropathy is based on a combination of clinical history, laboratory findings, and imaging studies. Key diagnostic features include:

• History of chronic analgesic use.
• Laboratory tests showing impaired renal function.
• Imaging studies, such as ultrasound or CT scan, revealing small, shrunken kidneys with papillary calcifications.

Management

Management of analgesic nephropathy involves:

• Discontinuation of the offending analgesic.
• Supportive care to manage symptoms and prevent further renal damage.
• Treatment of complications such as hypertension and electrolyte imbalances.
• In advanced cases, dialysis or kidney transplantation may be necessary.

Prevention

Preventive measures include:

• Limiting the use of analgesics, especially in individuals with risk factors for kidney disease.
• Monitoring renal function in patients requiring long-term analgesic therapy.
• Educating patients about the risks associated with chronic analgesic use.

Related Pages

• Chronic kidney disease
• Renal papillary necrosis
• Phenacetin
• Acetaminophen
• Aspirin