Elseviers MM, De Schepper A, Corthouts R, Bosmans J-L, Cosyn L, Lins RL, et al.
High diagnostic performance of CT scan for analgesic nephropathy in patients with incipient to severe renal failure

Kidney Int (Oct) 48:1316-1323 1995

At six Belgium dialysis units, all patients starting dialysis were questioned for a history of analgesic abuse. Of those without any other obvious diagnosis, 40 analgesic users and 40 control patients were investigated by renal tomography, ultrasonography, and CT scan. The former two imaging techniques have been found to be highly useful in detecting renal shrinkage and irregular renal surface as signs of analgesic use. However, they are both technique- dependent, and tomography also involves considerable radiation exposure. CT scan does not have these limitations. CT scan was found to be as good as the other two techniques in detecting decreased renal size. However, a finding of renal papillary calcifications was found to be the most highly predictive finding of analgesic nephropathy by CT scan (sensitivity 87%, specificity 97%). In a second study, 53 analgesic abusers with early renal failure (creatinine 1.5-4 mg/dL) were compared with 30 control patients with a variety of other renal diseases. In these patients the CT scan finding of papillary calcifications had a sensitivity of 92% and a specificity of 100%.

Calcifications may also be found in diabetes and obstruction, presumably because of papillary necrosis, as in analgesic nephropathy. Patients with renal tubular acidosis or primary hyperparathyroidism also may have renal calcification, but not discretely localized to the papillary line. These authors recommend use of CT scan for all patients with renal failure of unknown etiology to screen for analgesic nephropathy, even for patients without a history of analgesic use. (Paller)

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ARF etiology : Acute interstitial nephritis/NSAID
CRF by problems area : Etiology