What is analgesic nephropathy?

• When a person takes over-the-counter medications for pain that are classified as NSAIDs or nonsteroidal anti-inflammatory drugs on a regular/daily basis, they can develop a condition known as analgesic nephropathy. Painkillers that are taken occasionally and within the recommended dosage do not cause problems for persons with normal health kidneys. Painkillers with two or more that are taken one or a mix of these over-the-counter medicines daily over a long time may cause chronic kidney problems. This is called analgesic nephropathy. Painkillers that combine 2 or more medicines (such as Excedrin or Tylenol with codeine) have a much higher risk for persons.

What causes of analgesic nephropathy?

While doctors do not know exactly what causes analgesic nephropathy. They understand that daily doses of over-the-counter pain medicine or prescribed pain medicine such as Tylenol with codeine release metabolites as they are broken down in the body. These metabolites cause scaring of the small blood vessels in the nephrons. This is called capillary sclerosis. Capillary sclerosis can also be found in the renal pelvis and the ureter. Physicians believe that capillary sclerosis leads to renal papillary necrosis (an impairment of the blood supply in the kidney) and then chronic interstitial nephritis (long-term widespread inflammation).

What are the symptoms of analgesic nephropathy?

The most common symptoms of analgesic nephropathy:

• Fatigue or weakness
• Drowsiness, confusion, or lethargy
• Blood in the urine (hematuria)
• An increase in urination frequency or urgency
• Pain in the back or flank area (where the kidneys are located)
• A decrease in urine output
• Nausea, vomiting
• Widespread swelling (edema)
• Some people have no symptoms. Kidney damage may be picked up by routine blood tests. The symptoms of analgesic nephropathy may look like other medical conditions or problems. Always talk with your healthcare provider for a diagnosis.

How is analgesic nephropathy diagnosed?

Your healthcare provider will review your medical history and do a physical exam. Other tests may include:

• Blood pressure checks
• Urine toxicology screen. This test measures the amount of the painkiller in the urine.
• Urinalysis. Examine urine for certain types of cells and chemicals, such as red and white blood cells, infection, or too much protein.
• Complete blood count. This test measures the size, number, and maturity of blood cells.
• Exam of any tissue passed in the urine
• Intravenous pyelogram. A series of X-rays of the kidney, ureters, and bladder. It uses an injection of a contrast dye. This helps find tumors, abnormalities, kidney stones, or any blockages. This test also checks blood flow to the kidney.

What is the treatment for analgesic nephropathy?

Your healthcare provider will figure out the best treatment based on:

• How old you are
• Your overall health and past health
• How sick you are
• How well you can handle specific medicines, procedures, or therapies
• How long the condition is expected to last
• Your opinion or preference

Treatment may include:

• Stopping all painkillers you have been taking, especially OTC medicines
• Dietary changes
• Medicine
• Behavioral changes or counseling to help control chronic pain

Treatment aims to prevent any further kidney damage and treat any existing kidney failure.

What are the complications of analgesic nephropathy?

Some cases of acute kidney failure have been linked to the use of painkillers, including aspirin, ibuprofen, and naproxen. Many of these people had risk factors, such as:

• Lupus
• Advanced age
• Chronic kidney conditions
• Recent binge-drinking alcohol

Talk with your healthcare provider for more information about the diagnosis and treatment of analgesic nephropathy and kidney failure.

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