| Download the amazing global Makindo app: Android | Apple | |
|---|---|
| MEDICAL DISCLAIMER: Educational use only. Not for diagnosis or management. See below for full disclaimer. |
Analgesic Nephropathy
Related Subjects: |Metabolic acidosis |Lactic acidosis |Acute Kidney Injury (AKI) / Acute Renal Failure |Renal/Kidney Physiology |Chronic Kidney Disease (CKD) |Anaemia in Chronic Kidney Disease |Analgesic Nephropathy |Medullary Sponge kidney |IgA Nephropathy (Berger's disease) |HIV associated nephropathy (HIVAN) |Balkan endemic nephropathy (BEN) |Autosomal Dominant Polycystic kidney disease
⚠️ Analgesic Nephropathy is a form of chronic tubulointerstitial nephritis associated with long-term consumption of analgesics, particularly NSAIDs, paracetamol, and aspirin. Histologically, papillary necrosis is seen in most cases. It is an important, preventable cause of chronic kidney disease (CKD).
📍 About
- Most often due to prolonged, high-dose NSAID use.
- Can also occur with paracetamol and aspirin.
- Classically seen after cumulative dose ≈ 3 kg or daily intake >1 g for >3 years.
- More common in women (♀:♂ ratio ~6:1), typically >45 years old.
🧬 Aetiology & Pathophysiology
- Most commonly linked with propionic acid derivatives (e.g., ibuprofen, naproxen, fenoprofen).
- Mechanism: NSAID inhibition of renal prostaglandin synthesis → intra-renal vasoconstriction → medullary ischaemia → papillary necrosis.
- Direct toxic effect of paracetamol metabolites may also contribute.
🩺 Clinical Features
- Non-specific symptoms: fatigue, malaise, nausea, reduced urine output.
- Renal angle pain, flank pain, haematuria (if papillary necrosis occurs).
- Features of CKD: oedema, anaemia, hypertension.
- Can present as acute kidney injury (AKI) or progress insidiously to end-stage renal disease (ESRD).
🔬 Investigations
- Bloods: U&E (↑ creatinine, ↑ K⁺), FBC (anaemia), consider metabolic acidosis (Type IV RTA with low renin).
- Urine: Proteinuria (often nephrotic-range in 80%), microscopic haematuria.
- Imaging:
- Ultrasound: cortical scarring, small kidneys, evidence of papillary necrosis.
- X-ray/CT: calcification around renal papillae (“garland” sign).
- Non-contrast CT increasingly used to exclude/confirm papillary necrosis.
- Renal biopsy: Rarely required. Shows chronic interstitial nephritis, papillary necrosis, interstitial fibrosis. May see minimal change disease or membranous nephropathy with NSAIDs.
💊 Management
- Immediate discontinuation of analgesics (esp. NSAIDs).
- Optimise hydration and control blood pressure (RAAS blockade if tolerated).
- Monitor renal function (creatinine clearance, eGFR) and electrolytes.
- Surveillance for urothelial cancers (renal pelvis, ureters) via haematuria monitoring, as risk is increased.
- Referral to nephrology if CKD stage ≥3 or progressive decline.
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
|
|
Categories
- A Level
- About
- Acute Medicine
- Anaesthetics and Critical Care
- Anatomy
- Anatomy and Physiology
- Biochemistry
- Book
- Cardiology
- Collections
- CompSci
- Crib Sheets
- Crib sheets
- Dental
- Dermatology
- Differentials
- Drugs
- ENT
- Education
- Electrocardiogram
- Embryology
- Emergency Medicine
- Endocrinology
- Ethics
- Foundation Doctors
- GCSE
- Gastroenterology
- General Practice
- Genetics
- Geriatric Medicine
- Guidelines
- Gynaecology
- Haematology
- Hepatology
- Immunology
- Infectious Diseases
- Infographic
- Investigations
- Lists
- Mandatory Training
- Medical Students
- Microbiology
- Nephrology
- Neurology
- Neurosurgery
- Nutrition
- OSCE
- OSCEs
- Obstetrics
- Obstetrics Gynaecology
- Oncology
- Ophthalmology
- Oral Medicine and Dentistry
- Orthopaedics
- Paediatrics
- Palliative
- Pathology
- Pharmacology
- Physiology
- Procedures
- Psychiatry
- Public Health
- Radiology
- Renal
- Respiratory
- Resuscitation
- Revision
- Rheumatology
- Statistics and Research
- Stroke
- Surgery
- Toxicology
- Trauma and Orthopaedics
- USMLE
- Urology
- Vascular Surgery