Kidney nontumor / medical renal
Tubulointerstitial disease
Drug and toxin related tubulointerstitial injury
Analgesic nephropathy
Author: Nikhil Sangle, M.D.
Last author update: 26 November 2018
Last staff update: 15 July 2022
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PubMed Search: Analgesic nephropathy pathology
Table of Contents
Definition / general | Clinical features | Case reports | Gross description | Microscopic (histologic) description | Microscopic (histologic) imagesCite this page: Sangle N. Analgesic nephropathy. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/kidneyanalgesicabuse.html. Accessed April 29th, 2025.
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
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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
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
Images hosted on other servers:
Various images
