Thursday, April 27, 2017

Introduction To Analgesic Nephropathy

Analgesic Nephropathy is a condition that is associated with prolonged, heavy use of analgesics that leads to decline in renal function due to chronic papillary necrosis and chronic diffuse tubulointerstitial damage to renal cortex.

The incidence of analgesic nephropathy has declined significantly after the withdrawal of phenacetin use.

Clinical Features
  • Patients with analgesic nephropathy are unable to produce maximally concentrated urine due to underlying medullary and papillary damage.
  • They present with repeated UTI’s and or urinary abnormalities on urinalysis like hematuria, proteinuria, casts etc.
  • Anemia is more severe as compared to level of renal insufficiency.
  • Distal tubular acidosis associated with analgesic nephropathy contributes to the development of nephrocalcinosis.
  • Kidneys become shrunken and calyces are deformed producing “ring sign” on IVP that is pathognomonic of papillary necrosis.
  • Transitional cell carcinoma may develop in the urinary pelvis or ureters as a late complication of analgesic abuse.
  • Stop the analgesics.
  • Antibiotics for infection.
  • Drainage for obstruction.
  • Dialysis or transplantation for end stage renal disease.

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