THE ASSOCIATION OF PEPTIC ULCERATION, CHRONIC RENAL DISEASE, AND ANALGESIC ABUSE

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Abstract
Patients are described who have both peptic ulcers and chronic renal disease together with a history of prolonged analgesic abuse. Psychological instability may predispose to the high analgesic intake. The symptoms of peptic ulceration were frequently resistant to medical management and a gastrectomy had been performed in more than half the patients studied. The renal features are those of renal papillary necrosis and bacterial invasion of the kidney did not seem to play an important role. Although urinary tract infection was present at some time in two-thirds of the patients the most frequent urinary finding was a sterile pyuria. Patients with renal papillary necrosis showed a much higher incidence of hypertension than has been previously recorded. Anaemia is a prominent feature and seems to be due to occult gastrointestinal blood loss and uraemia. The diagnosis is frequently missed if only one radiological examination is made. Progressive changes in serial radiographs more often reveal it.