Kidney and bladder health

Updated 26 February 2019

What is analgesic nephropathy?

Painkillers could harm your health.

Pain killers, commonly known as analgesics, help to relieve pain. For most people, pain killers aren’t dangerous when taken at the recommended dosage. But if you take one too many, you could harm your body. Analgesic nephropathy is a chronic kidney disease that can lead to irreversible kidney failure and the permanent need for dialysis, or a kidney transplant to restore kidney function. 

It’s estimated that about four out of every 100 000 people will develop analgesic nephropathy. Women older than 30 are most at risk.

What causes analgesic nephropathy?

It’s caused by the excessive long-term use of painkillers (analgesics).Over-the-counter (OTC) painkillers that contain phenacetin or acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen are thought to be particularly high risk.Excessive use has been described as roughly three pills per day for six years.

Other factors associated with an increased risk include:

  • Chronic headache, backache, or musculoskeletal pain.
  • A history of dependent behaviours.
  • Painful menstrual periods.

Possible symptoms include:

  • Weakness.
  • Tiredness
  • Increased urinary frequency or urgency.
  • Blood in the urine.
  • Decreased urine output.
  • Flank or back pain.
  • Decreased alertness.
  • Numbness.
  • Nausea.
  • Swelling.
  • Easy bruising and bleeding.

How is it treated?

The aim of treatment is to prevent any further kidney damage and to treat the existing damage. Further damage can usually be limited by stopping the use of the painkiller that's causing the kidney failure. Counselling or behaviour modifications may be required to find non-pharmaceutical ways of handling chronic pain.

Depending on the extent of the kidney damage, you may be advised to change your diet, limit your fluid in-take, or take medications to avoid anaemia and bone problems caused by kidney disease.Your doctor will monitor your kidney function with regular urine and blood tests.In severe cases, dialysis or a kidney transplant may be necessary.What is the prognosis?Kidney damage may be acute and temporary or chronic and long-term. In severe cases, dialysis or a kidney transplant may be necessary.

Possible complications may include:

  • Hypertension
  • Urinary tract infections
  • Interstitial nephritis
  • Renal failure
  • Tissue death
  • Transitional cell carcinoma of the kidney or ureter

When to call your doctor

Call your doctor if you experience any of the symptoms of analgesic nephropathy, especially if you have been using painkillers over a long and sustained period of time. Also call your doctor if you have blood or solid material in your urine, or a decrease in urinary output. How can it be prevented? Use medications strictly in accordance with your doctor's advice. In the case of over-the-counter painkillers, do not exceed the recommended dosage on the pack.

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