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Analgesic Nephropathy

Illustration of the anatomy of the kidney
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What is analgesic nephropathy?

An analgesic is any medicine intended to alleviate pain. Over-the-counter analgesics include the following:

  • aspirin
  • acetaminophen
  • ibuprofen
  • naproxen sodium

Some conditions make taking these common painkillers dangerous for the kidneys. Taking one, or a combination of, these drugs regularly over a long period of time may increase the risk of kidney problems.

Analgesic nephropathy is a chronic kidney disease that gradually leads to end-stage renal disease and the need for permanent dialysis or a kidney transplant to restore renal function. It can result from taking painkillers every day for several years. And, the painkillers that combine two or more analgesics (for example, aspirin and acetaminophen together) with caffeine or codeine are the most likely to damage the kidneys. These mixtures are often sold as powders. Analgesic nephropathy occurs in four out of 100,000 people, usually in women over 30 years of age.


People who take any painkillers on a regular basis should consult their physicians to make sure they are not causing damage to their kidneys.

In addition, patients with conditions that put them at risk for acute kidney failure should consult their physicians before taking any medications (over-the-counter or prescription).

What are the symptoms of analgesic nephropathy?

The following are the most common symptoms of analgesic nephropathy. However, each individual may experience symptoms differently. Symptoms may include:

  • fatigue or weakness
  • blood in the urine
  • an increase in urination frequency or urgency
  • pain in the back or flank area (where the kidneys are located)
  • a decrease in urine output
  • decreased alertness such as drowsiness, confusion/delirium, or lethargy
  • decreased sensation or numbness, especially in the extremities
  • nausea, vomiting
  • generalized swelling
  • easy bruising or bleeding

Some patients experience no symptoms. The symptoms of analgesic nephropathy may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is analgesic nephropathy diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for analgesic nephropathy may include the following:

  • blood pressure measurement

  • urine toxicology screen

  • urinalysis - laboratory examination of urine for various cells and chemicals, such as red blood cells, white blood cells, infection, or excessive protein.

  • complete blood count (CBC) - a measurement of size, number, and maturity of the different blood cells in a specific volume of blood.

  • examination of any tissue passed in the urine

  • intravenous pyelogram (IVP) - a series of x-rays of the kidney, ureters, and bladder with the injection of a contrast dye into the vein - to detect tumors, abnormalities, kidney stones, or any obstructions, and to assess renal blood flow.

Treatment for analgesic nephropathy:

Specific treatment for analgesic nephropathy will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment may include:

  • discontinuation of all suspect analgesics, especially over-the-counter (OTC) medications

  • dietary modifications

  • medication

  • behavioral modification or counseling as an alternative method of chronic pain control

Treatment focuses on preventing any further kidney damage, and treatment of any existing kidney failure.

What is acute kidney failure?

Some reports have attributed incidents of acute kidney failure to the use of painkillers, including aspirin, ibuprofen, and naproxen. Many of the patients in these reports had risk factors such as the following:

  • systemic lupus erythematosus (lupus)
  • advanced age
  • chronic renal conditions
  • a recent binge of alcohol consumption

Consult your physician for more information about diagnosis and treatment of analgesic nephropathy and acute kidney failure.

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