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Analgesic nephropathy selectively affecting a unilateral non-functioning hypoplastic kidney.

J Granese¹, K Brightbill, P Osborne

¹Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.

Clinical Nephrology

|August 29, 2007

Summary

Chronic analgesic abuse can cause kidney damage. This case highlights how even therapeutic doses of acetaminophen and naproxen may lead to severe analgesic nephropathy, particularly in individuals with pre-existing kidney issues.

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Area of Science:

Nephrology
Pharmacology
Toxicology

Background:

Analgesic nephropathy is typically linked to chronic overuse of non-narcotic analgesics, often involving phenacetin or mixed preparations.
Histopathology reveals renal papillary necrosis and chronic interstitial nephritis with progressive scarring, usually affecting both kidneys bilaterally.

Observation:

This report details a unique case of severe analgesic nephropathy affecting a single, non-functioning kidney while sparing the contralateral healthy kidney.
The patient had a history of consuming therapeutic daily doses of acetaminophen and naproxen for several years.

Findings:

Estimated cumulative doses were approximately 1.0 kg of acetaminophen and 0.4 kg of naproxen.
The acetaminophen dose approached the threshold associated with end-stage kidney failure risk.
Simultaneous use of both analgesics may have potentiated adverse renal effects.

Implications:

This case underscores that pre-existing renal insufficiency may be a prerequisite for developing analgesic nephropathy.
Normally functioning kidneys appear more resistant to the chronic nephrotoxicity of habitual analgesic use.