analgesic nephropathy definition clinical presentation diagnosis differential diagnosis treatment other effects of NSAIDS on kidney

1. 11
Analgesic NephropathyAnalgesic Nephropathy
Dr. MohamedAbbassDr. MohamedAbbass
NephrologistNephrologist
PGDD,CARDIFF,UKPGDD,CARDIFF,UK

2. Renal disease characterized byRenal disease characterized by
chronic interstitial nephritischronic interstitial nephritis (CIN)(CIN)
and renal papillary necrosisand renal papillary necrosis(RPN)(RPN)
caused by prolonged and excessivecaused by prolonged and excessive
consumption of analgesicconsumption of analgesic mixturesmixtures

3. The nephrotoxic effect ofThe nephrotoxic effect of
phenacetinphenacetin is dose dependentis dose dependent
(cumulative effect)(cumulative effect)
Some sources has reported thatSome sources has reported that
the patient must take aboutthe patient must take about oneone
gram per day for two yeargram per day for two year to haveto have
analgesic nephropathyanalgesic nephropathy

4. ANAN waswas one of the most commonone of the most common
causes of chronic kidney diseasecauses of chronic kidney disease
CKDCKD especially in Australia andespecially in Australia and
part of Europepart of Europe but now markedbut now marked
declinedecline after withdrawal ofafter withdrawal of
phenacetinphenacetin

5. The most common causes areThe most common causes are
mixtures containingmixtures containing phenacetin,phenacetin,
aspirin and caffeineaspirin and caffeine especially theespecially the
medicationmedication over-the-counterover-the-counter

6. Long-term use ofLong-term use of aspirinaspirin
alone is not associated withalone is not associated with
analgesic nephropathyanalgesic nephropathy

7. AspirinAspirin can potentiate the nephrotoxiccan potentiate the nephrotoxic
effect of phenacetin and acetaminopheneffect of phenacetin and acetaminophen
1- Inhibit the cyclooxygenase enzymes1- Inhibit the cyclooxygenase enzymes
which lead to suppress prostaglandinwhich lead to suppress prostaglandin
2- Deplete glutathione which is2- Deplete glutathione which is
responsible for detoxification of theresponsible for detoxification of the
reactive intermediate of acetaminophenreactive intermediate of acetaminophen
and phenacetinand phenacetin

8. Pathogenesis and PathologyPathogenesis and Pathology

10. Clinical featuresClinical features

13. InvestigationsInvestigations

14. No "gold Test" to diagnoseNo "gold Test" to diagnose
analgesic nephropathyanalgesic nephropathy

15. All tests are suggestive and can be happenAll 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

16. Differential diagnosisDifferential diagnosis

17. Sickle cell diseaseSickle cell disease
Chronic pyelonephritisChronic pyelonephritis
DiabetesDiabetes
Renal tuberculosisRenal tuberculosis
Urinary tract obstructionUrinary tract obstruction
Polycystic kidney diseasePolycystic kidney disease
NephrosclerosisNephrosclerosis
Causes of chronic tubulointerstitialCauses of chronic tubulointerstitial (Multiple(Multiple
myeloma, Sarcoid nephropathy)myeloma, Sarcoid nephropathy)

18. TreatmentTreatment

20. Renal syndromes associated withRenal 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

21. ThanksThanks
Dr M AbbassDr M Abbass