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Analgesic nephropathy

Phenacetin nephritis; Nephropathy - analgesic

Analgesic nephropathy involves damage to one or both kidneys caused by overexposure to mixtures of medicines, especially over-the-counter pain medicines (analgesics).

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Causes

Analgesic nephropathy involves damage within the internal structures of the kidney. It is caused by long-term use of analgesics (pain medicines), especially over-the-counter (OTC) drugs that contain phenacetin or acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen.

This condition frequently occurs as a result of self-medicating, often for some type of chronic pain.

Risk factors include:

Symptoms

There may be no symptoms in the beginning. Over time, as the kidneys are injured by the medicine, symptoms of kidney disease will develop, including:

Exams and Tests

The health care provider will examine you and ask about your symptoms. During the exam, your provider may find:

Tests that may be done include:

Treatment

The primary goals of treatment are to prevent further damage of the kidneys and to treat kidney failure. Your provider may tell you to stop taking all suspect painkillers, particularly OTC drugs.

To treat kidney failure, your provider may suggest diet changes and fluid restriction. Eventually, dialysis or kidney transplant may be needed.

Counseling may help you develop alternative methods of controlling chronic pain.

Outlook (Prognosis)

The damage to the kidney may be acute and temporary, or chronic and long term.

Possible Complications

Complications that may result from analgesic nephropathy include:

When to Contact a Medical Professional

Call your provider if you have any of the following:

Prevention

Follow your provider's instructions when using medicines, including OTC drugs. Do not take more than the recommended dose without asking your provider.

Related Information

Chronic
Over-the-counter pain relievers
Incidence
Headache
Alcohol use disorder
Urinary tract infection - adults
Cystitis - acute
Interstitial nephritis
Kidney stones
Prerenal azotemia
Heart failure - overview
Dehydration
Renal papillary necrosis
Acute kidney failure
Chronic kidney disease
Protein urine test
High blood pressure - adults
Cancer

References

Kelly CJ, Neilson EG. Tubulointerstitial diseases. In: Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu ASL, eds. Brenner and Rector's The Kidney. 10th ed. Philadelphia, PA: Elsevier; 2016:chap 36.

Khan KNM, Hard GC, Alden CL. Kidney. In: Haschek WM, Rousseaux CG, Wallig MA, eds. Haschek and Rousseaux's Handbook of Toxicologic Pathology. 3rd ed. Waltham, MA: Elsevier Academic Press; 2013:chap 47.

Segal MS, Yu X. Herbal and over-the-counter medicines and the kidney. In: Johnson RJ, Feehally J, Floege J, eds. Comprehensive Clinical Nephrology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 78.

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Review Date: 8/1/2017  

Reviewed By: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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