Other names:
Analgesic Nephropathy is also known as phenacetin nephritis ,Nephropathy Analgesic ,Nsaid nephritis, Analgesic abuse Nephropathy
Definition:
- Analgesic nephropathy is usually happens a as a result of long term usage of NSAIDS or over the counter drugs which affects the kidney and responsible for its damage
- Few drugs include Aspirin, Acetaminophen,Ibuprofen,Naproxen sodium.
What causes Analgesic Nephropathy?
- Normally,the NSAIDS helps to reduce the pain and Inflammation by blocking the production of prostaglandins or PG’s
- Where as prostaglandin’s functions by dilating the afferent arterioles in the kidneys
allowing free blood flow to organ and thus increasing the Glomerular filtration rate as well
- When on NSAIDS as mentioned above ,the prostaglandins causes reduction in normal blood flow due to blockage of prostaglandins
- Certain levels of NSAIDS are advisable, especially higher dosages with regular uses are not healthy for the kidneys leading to kidney damage
- Microscopic examination reveals that the Renal tubular cells and medullary interstitial cells Are more prone for damage
- Over time passes this compromised cells sloughs off as sediments and comes out through urine
- The sediments might contain Proteins , Urinary casts,Crystals
Who is at risk?
- Elders of age ranging from 45-60 years are more prevalent than young
- Patients with pre-existing renal diseases
- Individuals on long term usage of over the counter drugs, Apart from NSAIDS having more than 1 active ingredient
- Consuming 6 or more than 6 pills a day for 3 years continuously
- History or addicted usage of Drugs such as Alcohol,Smoking,weed etc
- Individuals with chronic pain,painful Menstrual cramps,back pain, musculoskeletal pain and with emotional or behavioral changes are also prone to Analgesic Nephropathy.
- Individuals with reduced blood volume with usage of drugs
- Females are more impacted than males
What are the Symptoms of Analgesic Nephropathy?
Symptoms are not very common in every patient with analgesic nephropathy.Only Few might experiences all these or few of these symptoms over time and can have chronic tubulointerstitial nephritis or Hematuria due to papillary necrosis
- Nausea
- Vomiting
- Weakness
- Fatigue
- Hematuria
- Urinary urgency,irritability
- Decreased urine output
- Edema/swelling
- Bleeding or bruising
- Back or flank pain
- Confusion
- Drowsiness
- Decreased alertness
- Lethargy
- Decreased sensations
- Numbness
How is analgesic nephropathy diagnosed ?
After thorough examination through physical examination and history taking expert may advised to take basic to advance investigational procedures to confirm with the diagnosis
- First step include ,Checking Blood pressure levels
- Secondly Urine study includes Urinalysis,Urine toxicology screen
- Thirdly,total blood count
- Intravenous pyelogram not usually recommended because it is harmful for the patient
- Kidney ultrasound
- CT scan – non enhanced
- Elevated creatinine with urinalysis with Hematuria or sterile pyuria
- Mild proteinuria of less than 1.5 mg/ day
- CT scan reveals shrinked or small kidneys with bilateral renal papillary calcifications
Treatment
- Stop using drugs
- Suggest diet including healthy foods with less sodium and potassium levels
- Dialysis and transplantation
- Counseling on any related drug addictions
Complications
- Acute Kidney failure
- Chronic Kidney failure
- Interstitial nephritis
- Renal papillary necrosis
- Urinary tract infection
- Increased blood pressure
- Renal Cancer
Prognosis
- Variable and unpredictable results
- 3-5 %population can end up with end stage renal disease or ESRD
- Resulting in scarring of renal tissue and damage to renal parenchymal cells
Frequently asked questions
Is analgesic nephropathy reversible?
Yes ,if it is diagnosed at early stages of not can lead to an permanent kidney damage gradually leading to a failure which is irreversible and would require a definitive treatment including dialysis or transplantation
How long can you live with analgesic nephropathy?
This depends on the age, lifestyle, underlying conditions of patient and stage of the disease that patient has
For older age groups with stage 1 kidney disease the survival expectancy is about 12_15 years
It gradually decreases with the stage for around 13 years,8years,6 years and so on
At what GFR should Nsaids be stopped?
The recommended levels at which the NSAIDS should be stopped when the GFR is at less than 30 ml/min per 1.73 m²
Moreover the careful consideration is taken in the cases with GFR is in range between 30-59 ml/min per 1.73m².Should avoid prolonged usage
What is the safest NSAID to take long term for kidney?
Out of many subtypes of non steroidal Anti Inflammatory drugs Ibuprofen is considered as the safest drug to be chosen for the kidney patients as a part of long term regimen
The risk to lowering glomerular filtration rate,blood pressure associated with use of NSAIDs is quite rare and little less when compared with other NSAIDs
How is analgesic nephropathy treated?
Drugs including paracetamol, Acetaminophen and ibuprofen and newer drugs including COX -2 inhibitors are used to treat analgesic nephropathy related complications
What kind of kidney damage do NSAIDS cause?
Kidney damage of several kinds including hemodynamically mediated acute kidney injury (AKI),electrolyte and acid-base disorders,acute interstitial nephritis or (AIN), which may be associated with nephrotic syndrome and also papillary necrosis
Can GFR improve after stopping NSAID ?
In patients who stopped NSAID treatment have a significant improvement in eGFR levels,few studies shown increased results from 45.9 to 46.9, 23.9 to 27.1, and 12.4 to 26.4 ml/min per 1.73 m2 in 1340 stage 3 patients, 162 stage 4 patients, and 9 stage 5 patients, respectively.
How long does it take kidneys to recover from NSAID?
It takes around 3 to 9 days for kidneys to recover back to normal levels of creatinine and glomerular filtration rates .
Once the acute phase is controlled, the long-term outcomes are known to be excellent.
Does NSAIDS alter the GFR rates ?
Yes,NSAIDs gradually decreases the glomerular filtration rates .The risk is three times higher in the kidney disease patients when compared with normal healthy individuals on NSAID use
How do you protect your kidneys from NSAIDs?
Drug combinations including NSAIDs and angiotensin inhibitors should be restricted.
Some other basic preventive measures includes
Dietary salt restriction,
Use of topical NSAIDs
Use of calcium channel blockers for treating hypertension and
Non pharmacological therapies