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Analgesic nephropathy

Male urinary system

Definition

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

Alternative Names

Phenacetin nephritis; Nephropathy - analgesic

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.

References

Aronson JK. Paracetamol (acetaminophen) and combinations. In: Aronson JK, eds. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:474-493.

Parazella MA, Rosner MH. Tubulointerstitial diseases. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 35.

Segal MS, Yu X. Herbal and over-the-counter medicines and the kidney. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 76.


Review Date: 7/16/2019
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.