analgesic nephropathy

11Analgesic NephropathyAnalgesic Nephropathy

Dr. Mohamed AbbassDr. Mohamed AbbassNephrologistNephrologist

PGDD,CARDIFF,UKPGDD,CARDIFF,UK

Renal disease characterized by Renal disease characterized by chronic interstitial nephritis chronic interstitial nephritis (CIN) (CIN) and renal papillary necrosisand renal papillary necrosis(RPN) (RPN)

caused by prolonged and excessive caused by prolonged and excessive consumption of analgesic consumption of analgesic mixturesmixtures

The nephrotoxic effect of The nephrotoxic effect of phenacetinphenacetin is dose dependent is dose dependent

(cumulative effect) (cumulative effect)

Some sources has reported that Some sources has reported that the patient must take about the patient must take about one one

gram per day for two year gram per day for two year to have to have analgesic nephropathyanalgesic nephropathy

ANAN waswas one of the most common one of the most common causes of chronic kidney disease causes of chronic kidney disease CKD CKD especially in Australia and especially in Australia and part of Europe part of Europe but now marked but now marked

decline decline after withdrawal of after withdrawal of phenacetinphenacetin

The most common causes are The most common causes are mixtures containing mixtures containing phenacetin, phenacetin,

aspirin and caffeine aspirin and caffeine especially the especially the medication medication over-the-counter over-the-counter

Long-term use of Long-term use of aspirinaspirin alone is not associated with alone is not associated with

analgesic nephropathyanalgesic nephropathy

AspirinAspirin can potentiate the nephrotoxic can potentiate the nephrotoxic effect of phenacetin and acetaminopheneffect of phenacetin and acetaminophen

1- Inhibit the cyclooxygenase enzymes 1- Inhibit the cyclooxygenase enzymes which lead to suppress prostaglandin which lead to suppress prostaglandin 2- Deplete glutathione which is 2- Deplete glutathione which is responsible for detoxification of the responsible for detoxification of the reactive intermediate of acetaminophen reactive intermediate of acetaminophen and phenacetin and phenacetin

Pathogenesis and PathologyPathogenesis and Pathology

Clinical featuresClinical features

InvestigationsInvestigations

No "gold Test" to diagnose No "gold Test" to diagnose analgesic nephropathyanalgesic nephropathy

All tests are suggestive and can be happen All tests are suggestive and can be happen in other conditionsin other conditions

CBC Anemia

Urine analysis Haematuria or proteinuria or sterile pyuria

Urine histology Papillary necrosis (not pathognomonic of analgesic nephropathy)

Kidney function test Increase serum creatinine

Ultrasound or CT can show the classical features of analgesic nephropathy( CT is more sensitive)

•Small kidneys •Calcifications of the renal papilla•Irregular contour of the kidney

Intravenous pyelography •Partial or total papillary necrosis•Small kidneys•Blunted calyces

Differential diagnosisDifferential diagnosis

Sickle cell diseaseSickle cell diseaseChronic pyelonephritisChronic pyelonephritisDiabetesDiabetesRenal tuberculosisRenal tuberculosisUrinary tract obstructionUrinary tract obstructionPolycystic kidney diseasePolycystic kidney diseaseNephrosclerosisNephrosclerosisCauses of chronic tubulointerstitial Causes of chronic tubulointerstitial (Multiple (Multiple myeloma, Sarcoid nephropathy) myeloma, Sarcoid nephropathy)

TreatmentTreatment

Renal syndromes associated with Renal syndromes associated with NSAID useNSAID use

Acute kidney injury (hemodynamic ally-mediated or acute tubular necrosis(

Acute interstitial nephritis

Nephrotic syndrome (minimal change disease or membranous nephropathy(

Hyponatremia

Hyperkalemia/type 4 renal tubular acidosis

Hypertension/edema

Acute papillary necrosis

Chronic tubulointerstitial nephritis/analgesic nephropathy

ThanksThanks

Dr M AbbassDr M Abbass