Analgesic nephropathy

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  • 1Analgesic Nephropathy

    Dr. Mohamed AbbassNephrologistPGDD,CARDIFF,UK

  • Renal disease characterized by chronic interstitial nephritis (CIN) and renal papillary necrosis(RPN) caused by prolonged and excessive consumption of analgesic mixtures

  • The nephrotoxic effect of phenacetin is dose dependent (cumulative effect)

    Some sources has reported that the patient must take about one gram per day for two year to have analgesic nephropathy

  • AN was one of the most common causes of chronic kidney disease CKD especially in Australia and part of Europe but now marked decline after withdrawal of phenacetin

  • The most common causes are mixtures containing phenacetin, aspirin and caffeine especially the medication over-the-counter

  • Long-term use of aspirin alone is not associated with analgesic nephropathy

  • Aspirin can potentiate the nephrotoxic effect of phenacetin and acetaminophen

    1- Inhibit the cyclooxygenase enzymes which lead to suppress prostaglandin 2- Deplete glutathione which is responsible for detoxification of the reactive intermediate of acetaminophen and phenacetin

  • Pathogenesis and Pathology

  • Clinical features

  • Investigations

  • No "gold Test" to diagnose analgesic nephropathy

  • All tests are suggestive and can be happen in other conditions

  • Differential diagnosis

  • Sickle cell diseaseChronic pyelonephritisDiabetesRenal tuberculosisUrinary tract obstructionPolycystic kidney diseaseNephrosclerosisCauses of chronic tubulointerstitial (Multiple myeloma, Sarcoid nephropathy)

  • Treatment

  • Renal syndromes associated with NSAID use

  • ThanksDr M Abbass

    *Some sources has reported that the patient must take about one gram per day for two year to have analgesic nephropathy *****The renal medulla ( medullary loop of Henle , the vasa recta , and collecting ducts) because of low oxygen tension at this areaThe renal medulla blood flow depend on systemic and local production of vasodilator prostaglandin *************