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Kidney non-tumor

Drug related toxicity

Analgesic nephropathy

Reviewer: Nikhil Sangle, M.D. (see Reviewers page)
Revised: 2 September 2012, last major update September 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.


● 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

● 55 year old businessman with chronic osteoarthritis and end stage renal disease (Niger J Clin Pract 2012;15:231)

Gross description

● Depressed cortex due to cortical atrophy overlying necrotic papillae
● Papillae show varying stages of necrosis and sloughing

Micro 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

Micro images

Various images

End of Kidney non-tumor > Drug related toxicity > Analgesic nephropathy

Ref Updated: 7/5/12

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