The Evolution of Analgesic Nephropathy

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Abstract
A detailed pathological examination was made of the kidneys of 59 cases coming to autopsy in 1964 and known to have taken analgesics containing more than 2 kg of phenacetin. Definite abnormalities were found in 48 of the 59 cases. Papillary degeneration only was found with lower doses of phenacetin and appears to result from a direct toxic injury. Cortical changes of interstitial fibrosis, chronic inflammation, and tubular atrophy, seen with higher doses of analgesics may result from obstruction in the papilla. With papillary degeneration they constitute the essential features of analgesic nephropathy. Pyelonephritis, though common, is a secondary phenomenon.