ANALGESIC NEPHROPATHY - IMPORTANT CAUSE OF CHRONIC RENAL-FAILURE

  • 1 January 1978
    • journal article
    • research article
    • Vol. 47  (185) , 49-+
Abstract
Study of case-notes and autopsy reports of patients with renal disease suggests that analgesic nephropathy is responsible for at least 12% of cases of chronic renal failure. Between 1970-1975, 8 new cases of analgesic nephropathy were seen annually in a population of 750,000. This is equivalent to an incidence of 490 new cases/yr in England and Wales. Patients [55] with analgesic nephropathy were followed 1-84 mo. for a total of 190 patient yr. Changes in renal function were correlated with bacteriuria, hypertension and analgesic consumption. One third of the cases were misdiagnosed, and analgesic abuse was only revealed by thorough examination of case-notes and autopsy records, together with careful questioning of patients and relatives. A number of cases had been classified as chronic pyelonephritis. Calculated survival rate at 5 yr was 44%. Mortality was related to level of analgesic consumption and degree of renal failure at time of diagnosis. The prognosis was poor if serum creatinine at presentation was greater than 400 .mu.mol/l. There was no significant correlation between deterioration in renal function and bacteriuria or hypertension. Of the patients, 42% were taking analgesics for arthritis: 27% had rheumatoid arthritis. Most had been taking large quantities of analgesic mixtures containing phenacetin. Renal papillary necrosis was present in only 26% on i.v. urography, but was found in all those examined at autopsy. Autopsy reports [20,229] were examined for the presence of renal disease. Renal papillary necrosis was found in 0.41% and could be attributed to analgesic nephropathy in 24%. In patients under 65 yr of age, analgesic nephropathy appeared to be a more frequent cause of death than chronic pyelonephritis. The report indicates the need for careful enquiry about analgesic consumption in all patients with renal disease and emphasizes the importance of early diagnosis and cessation of analgesics in suspected cases of analgesic nephropathy.

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