Analgesic Nephropathy

Overview, Causes, & Risk Factors

Analgesic nephropathy refers to kidney damage caused by regular, long-term useof painmedicines. Short-term, occasional use of these medicines does notseem to cause kidney damage.

What is going on in the body?

Pain medicines may cause kidney damage when a persontakes more than 6 to 8 pills every day for several years. This kind oflong-term use of pain relievers can occur in people with chronic headaches, backpain, or other chronicpain syndromes.

These medicines cause kidney damage in two different ways. The first way iscalled chronic interstitial nephritis. In this disorder,inflammatory cells cause scarring and result in damaged, shrunken kidneys. Thesecond way is called papillary necrosis. In this case, the inner kidney diesand sloughs off, leaving a damaged kidney. The damage due to these painmedicines occurs slowly, over many years. It is usually notdiagnosed until severe damage has occurred.

What are the causes and risks of the disease?

Analgesic nephropathy is caused by long-term, regular use ofpainmedicines. These medicines include acetaminophen, aspirin, andnonsteroidal anti-inflammatory drugs, or NSAIDs. Ibuprofen and naproxen areexamples of NSAIDs. Those with chronic pain are more likely to use thesemedicines in a way that causes kidney damage. Medicines that combine two ormore analgesics together with caffeine or codeine are most likely to causedamage. These medicines are often sold as powders containing acetaminophen andaspirin with caffeine.

Symptoms & Signs

What are the signs and symptoms of the disease?

Signs and symptoms of analgesic nephropathy usually come on slowly and mayinclude:

  • dehydration
  • fatigue
  • headaches
  • high blood pressure
  • an increase in the frequency of urination
  • jointpain
  • Symptoms of kidney failure may include:

  • confusion
  • decrease in the frequency of urination
  • difficulty breathing, or shortness of breath
  • extreme tiredness, or fatigue
  • generalized swelling
  • hiccups
  • a metallic taste in the mouth
  • nausea and vomiting
  • Diagnosis & Tests

    How is the disease diagnosed?

    Diagnosis of analgesic nephropathy begins with a history andphysical exam. Kidney function tests will be ordered. A blood testcalled CHEM-7 can help diagnose kidney damage or failure. A urinalysiscan also help detect problems with kidney function.

    Imaging tests, such as an ultrasound or a CT scan, may be ordered. Thesetests check the size of the kidneys and detect some problems. A biopsy of thekidney may be done as well. This involves inserting a special needle through aperson’s back and into the kidney. A small piece of the kidney is removed withthe needle. This sample is sent to the lab for examination and testing.

    Prevention & Expectations

    What can be done to prevent the disease?

    Analgesic nephropathy can be prevented by limiting the use ofpainmedicines.

    What are the long-term effects of the disease?

    Kidney function may improve if this condition is caught early and the personstops taking the pain medicines. However, kidney failure is oftenpresent by the time the diagnosis is made. This type of kidney damage is notusually reversible.

    A person with kidney failure needsdialysis or a kidney transplant to survive. Dialysis is aprocedure to filter the blood. It requires a person to be hooked up to aspecial blood-filtering machine, sometimes as often as three times a week. Thiscontinues for life or unless the person gets a kidney transplant.

    What are the risks to others?

    Analgesic nephropathy is not contagious and poses no risks toothers.

    Treatment & Monitoring

    What are the treatments for the disease?

    A person with analgesic nephropathy is advised to stop using painmedicines. If the condition is caught early, this may be the onlytreatment that is needed. If kidney failure is present, the person will needeither dialysis or a kidney transplant. The person may also needtreatment for high blood pressure.

    What are the side effects of the treatments?

    Dialysis has many side effects, including infection, saltimbalances, and even death. Surgery can cause bleeding, infection,or allergic reaction to anesthesia.

    After a kidneytransplant, a person must take powerful medicines to prevent thebody from rejecting the new kidney. These medicines increase the person’s riskof infections. They may damage the new kidney and cause other side effects.Blood pressure medicines may cause fatigue, lightheadedness, and erectiledysfunction.

    What happens after treatment for the disease?

    Those with only mild kidney damage who stop using pain medicines may beable to lead a normal life. Those with kidney failure usually need treatmentfor the rest of their lives.

    How is the disease monitored?

    Kidney function is usually monitored with regular blood and urine tests. Anynew or worsening symptoms should be reported to the healthcareprovider.

    Article type: xmedgeneral

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