Internal Medicine

P1: SBT

0521779407-03 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 19:6

Analgesic Nephropathy 119

NSAID – Induced Acute Renal Failure

■rapidly progressive renal failure

■Membranous nephropathy

■Minimal change disease

■acute renal failure secondary to hypovolemia/hypotension

■vasculitis

■Membranoproliferative glomerulonephritis

■Lupus

■Wegener’s granulomatosis

■Goodpasture’s syndrome

■acute interstial nephritis secondary to drugs, infection

■any acute glomerulonehritis

management

What to Do First

■discontinue analgesic use. This may require considerable psycho-

General Measureslogical support and guidance

■increase fluid intake

■control blood pressure

■monitor for progressive decline in creatinine clearance

■monitor for transitional cell carcinoma of renal pelvis and ureters

using checks for hematuria

specific therapy

■stop or minimize analgesic use.

follow-up

■course depends on severity of renal damage at the time of presenta-

tion

■decline in renal function will continue if analgesic use is continued

■check periodic serum creatinine values.

■urinalysis (especially for proteinuria and hematuria)

■blood pressure control

■increased atherosclerotic disease

complications and prognosis

■prognosis is good if caught early and analgesic use stopped.

■progression to end stage renal failure can occur