What is analgesic nephropathy?

Analgesics are painkillers. Examples include:

• Aspirin

• Acetaminophen

• Ibuprofen

• Naproxen sodium

Taking one or a mix of these medicines daily over a long time may cause chronic kidney problems. This is called analgesic nephropathy. Painkillers that combine 2 or more medicines (such as, aspirin and acetaminophen together) with caffeine or codeine are the most likely to harm the kidneys. Painkillers with codeine require a prescription.

What causes analgesic nephropathy?

Long-term exposure to certain painkillers can damage the small filtering blood vessels in the kidneys. This can cause analgesic nephropathy, a chronic kidney problem.

What are the symptoms of analgesic nephropathy?

These are the most common symptoms of analgesic nephropathy: 

• Fatigue or weakness, feeling unwell

• Blood in the urine (hematuria)

• 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, or lethargy

• Decreased feeling or numbness, especially in the arms and legs

• Nausea, vomiting

• Widespread swelling (edema)

• Easy bruising or bleeding

Some people have no symptoms. Kidney damage may be picked up by routine blood tests. The symptoms of analgesic nephropathy may look like other medical conditions or problems. Always talk with your healthcare provider for a diagnosis.

How is analgesic nephropathy diagnosed?

Your healthcare provider will review your medical history and do a physical exam. Other tests may include:

• Blood pressure checks.

• Urine toxicology screen. This test measures the amount of the pain killer in the urine.

• Urinalysis. Exam of urine for certain types of cells and chemicals, such as red and white blood cells, infection, or too much protein.

• Complete blood count. This test measures the size, number, and maturity of blood cells.

• Exam of any tissue passed in the urine.

• Intravenous pyelogram. A series of X-rays of the kidneys, ureters, and bladder. It uses an injection of a contrast dye. This helps find tumors, abnormalities, kidney stones, or any blockages. This test also checks blood flow to the kidneys.

What is the treatment for analgesic nephropathy?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment may include:

• Stopping all pain killers you have been taking, especially over-the-counter medicines

• Dietary changes

• Medicine

• Behavioral changes or counseling to help control chronic pain

Treatment aims to prevent any further kidney damage and treat any existing kidney failure. Talk with your healthcare provider for more information about the treatment of analgesic nephropathy and kidney failure.

What are possible complications of analgesic nephropathy?

Analgesic nephropathy increases your risk of getting urinary tract cancers and heart disease.

Key points about analgesic nephropathy

• Long-term use of pain killers can cause damage to the kidneys. This includes over-the-counter and prescription pills.

• This condition is most common in people older than age 45. It is more prevalent in women older than age 30.

• Often there are no symptoms. It may be found on routine blood or urine tests.

• Symptoms are related to the buildup of toxins and waste products that are normally filtered by the kidneys.

• Analgesic nephropathy can lead to acute kidney failure, cancer, or atherosclerosis in later stages.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.