Analgesic nephropathy overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]
Overview
The term analgesic nephropathy usually refers to damage induced by excessive use of combinations of these medications, specifically combinations that include phenacetin. For this reason, it is also called analgesic abuse nephropathy. Others prefer the less judgmental analgesic-associated nephropathy. Both terms are abbreviated to the acronym AAN, by which the condition is also commonly known.
Analgesic nephropathy is injury to the kidney caused by analgesic medications such as aspirin, phenacetin, and paracetamol. The term usually refers to damage induced by excessive use of combinations of these medications, especially combinations that include phenacetin. It may also be used to describe kidney injury from any single analgesic medication.
The specific kidney injuries induced by analgesics are renal papillary necrosis and chronic interstitial nephritis. They appear to result from decreased blood flow to the kidney, rapid consumption of antioxidants, and subsequent oxidative damage to the kidney. This kidney damage may lead to progressive chronic renal failure, abnormal urinalysis results, high blood pressure, and anemia. A small proportion of individuals with analgesic nephropathy may develop end-stage kidney disease.
Analgesic nephropathy was once a common cause of kidney injury and end-stage kidney disease in parts of Europe, Australia, and the United States. In most areas, its incidence has declined sharply since the use of phenacetin fell in the 1970s and 1980s.
Overview
Historical Perspective
In 1953, the association between analgesic drugs and chronic renal disease was first reported in German.[1] In 1977, phenacetin became legally banned in Australia.[2] In 1978 and 1983, phenacetin was withdrawn from the Canadian and US markets, respectively.[3][4]
Pathopysiology
Causes
Differentiating Analgesic nephropathy from other Diseases
Risk Factors
Screening
There is insufficient evidence to recommend routine screening for analgesic nephropathy.
Natural History, Complications and Prognosis
The prognosis of analgesic nephropathy depends on the scarring and damage to the renal tissue. Most patients in early stages recover to normal renal function after stopping the analgesic drug, however some may progress to end stage renal disease (ESRD). Complications of analgesic nephropathy include: urinary tract infections, varying degrees of renal failure and End stage renal disease (ESRD).[5][6][7]
Epidemiology and Demographics
There is insufficient evidence about the incidence, prevalence and racial predilection of analgesic nephropathy. Most patients with analgesic nephropathy have been reported to be middle age or older with a history of chronic pain.[8] There is insufficient evidence that suggests gender predilection in analgesic nephropathy. However, some studies suggest that analgesic nephropathy is more conman in females than males.[9]
Diagnosis
Diagnostic Study of Choice
Renal biopsy is the diagnostic study of choice, however, since it is an invasive procedure, CT scan without contrast of the abdomen is usually preferred.[10][11]
History and Symptoms
Common findings in patients with analgesic nephropathy include: headache, upper gastrointestinal disease (such as peptic ulcer), anemia, urinary tract infections, pyuria and hypertension.[5][6]
Physical Examination
In physical examination of patients with analgesic nephropathy checking for the followings should be considered: headache, upper gastrointestinal disease (such as peptic ulcer), anemia, urinary tract infections, and hypertension.[5][6]
Laboratory Findings
The laboratory tests and findings in analgesic nephropathy may include: urinary examination (sterile pyuria, hematuria, proteinuria and bacteriuria) and blood tests (anemia and renal failure).[5][6][7]
Electrocardiogram
There are no ECG findings associated with analgesic nephropathy.
X-ray
A pyelogram is not helpful in the diagnosis of analgesic nephropathy and may worsen the renal injury due to contrast utilization.[10]
Ultrasound
There are no ultrasound findings associated with analgesic nephropathy. However, ultrasound of the abdomen, kidneys and the urinary bladder could be helpful in ruling out other causes of nephropathy (obstruction or infection).[7]
CT Scan
CT scan without contrast of the abdomen is usually preferred for diagnosing analgesic nephropathy, the findings include: decrease in renal size, bumpy contours and papillary calcifications.[11]
MRI
There is insufficient evidence suggesting MRI findings associated with analgesic nephropathy.
Other Imaging Findings
There are no other imaging findings associated with analgesic nephropathy.
Other Diagnostic studies
There are no other diagnostic studies associated with analgesic nephropathy.
Treatment
Medical therapy
Interventions
Surgery
Prevention
It has been suggested that in clinical practice, non-opioid analgesics, when possible, should be avoided for long-term use due to their nephrotoxicity.[8]
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Further randomized trials are required to assess the incidence of renal injury and analgesic nephropathy caused by certain drugs.[8]
References
- ↑ Spühler O, Zollinger HU (1953). "Die chronisch-interstitielle Nephritis". Z Klin Med (in German). 151 (1): 1–50. PMID 13137299.
- ↑ Michielsen P, de Schepper P (2001). "Trends of analgesic nephropathy in two high-endemic regions with different legislation". J Am Soc Nephrol. 12 (3): 550–6. PMID 11181803.
- ↑ "Some pharmaceutical drugs". IARC Monogr Eval Carcinog Risk Chem Hum. 24: 1–337. 1980. PMID 6937434.
- ↑ "List of drug products that have been withdrawn or removed from the market for reasons of safety or effectiveness. Food and Drug Administration, HHS. Final rule". Fed Regist. 64 (44): 10944–7. 1999. PMID 10557618.
- ↑ 5.0 5.1 5.2 5.3 Nanra RS (1980). "Clinical and pathological aspects of analgesic nephropathy". Br J Clin Pharmacol. 10 Suppl 2: 359S–368S. doi:10.1111/j.1365-2125.1980.tb01824.x. PMC 1430193. PMID 7002190.
- ↑ 6.0 6.1 6.2 6.3 Nanra RS, Stuart-Taylor J, de Leon AH, White KH (1978). "Analgesic nephropathy: etiology, clinical syndrome, and clinicopathologic correlations in Australia". Kidney Int. 13 (1): 79–92. doi:10.1038/ki.1978.11. PMID 362034.
- ↑ 7.0 7.1 7.2 "StatPearls". 2020. PMID 31082145.
- ↑ 8.0 8.1 8.2 Yaxley J (2016). "Common analgesic agents and their role in analgesic nephropathy: A commentary of the evidence". Int J Risk Saf Med. 28 (4): 189–196. doi:10.3233/JRS-170735. PMID 28582877.
- ↑ Gault MH, Wilson DR (1978). "Analgesic nephropathy in Canada: clinical syndrome, management, and outcome". Kidney Int. 13 (1): 58–63. doi:10.1038/ki.1978.8. PMID 713269.
- ↑ 10.0 10.1 "Analgesic Nephropathy - StatPearls - NCBI Bookshelf".
- ↑ 11.0 11.1 de Broe ME, Elseviers MM (1998). "Analgesic nephropathy". N. Engl. J. Med. 338 (7): 446–52. PMID 9459649. Unknown parameter
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