Kidney nontumor
Drug related toxicity
Analgesic nephropathy

Author: Nikhil Sangle, M.D. (see Authors page)

Revised: 21 March 2018, last major update September 2012

Copyright: (c) 2003-2018,, Inc.

PubMed Search: Analgesic nephropathy [title] pathology

Cite this page: Sangle, N. Analgesic nephropathy. website. Accessed October 23rd, 2018.
Definition / general
  • Bilateral chronic renal disease due to excessive intake of analgesics, with papillary necrosis (tips of medullary pyramids) and later chronic tubulointerstitial nephritis
  • Disorder appears to be limited to phenacetin containing analgesics (Nephrol Dial Transplant 2009;24:1253)
Clinical features
  • High rates in Australia (Clin J Am Soc Nephrol 2008;3:768), southeast USA
  • Due to red blood cell damage from phenacetin metabolites in numerous products: phenacetin plus aspirin, caffeine, acetaminophen (a metabolite of phenacetin) or codeine
  • 80% women; also people with chronic pain, factory workers
  • 50% have co-existing urinary tract infection
  • Anemia, renal stones and inability to concentrate urine
  • May have gross hematuria or renal colic due to sloughing of necrotic papillae
  • Complication: papillary urothelial carcinoma of renal pelvis

    Other causes of papillary necrosis:
  • Diabetes mellitus: 75% women, usually 10+ years of disease, 80% have urinary tract infection, all papillae affected similarly
  • Obstruction: 90% male, 90% have infection, frequent calcification
  • Sickle cell disease: M=F, few papillae affected
Case reports
Gross description
  • Depressed cortex due to cortical atrophy overlying necrotic papillae
  • Papillae show varying stages of necrosis and sloughing
Microscopic (histologic) description
  • Early: papillae have patchy necrosis
  • Later: papillae are diffusely necrotic with ghost tubules and dystrophic calcification; renal columns of Berlin are usually spared from tubular atrophy; small vessels have basement membrane thickening
Microscopic (histologic) images

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