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
(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
40 analgesic users and 40 control patients were investigated by renal
tomography, ultrasonography, and CT scan. The former two imaging techniques
been found to be highly useful in detecting renal shrinkage and irregular
surface as signs of analgesic use. However, they are both technique-
and tomography also involves considerable radiation exposure. CT scan does
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
analgesic nephropathy by CT scan (sensitivity 87%, specificity 97%). In a
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
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
patients with renal failure of unknown etiology to screen for analgesic
nephropathy, even for patients without a history of analgesic use.
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ARF etiology :
Acute interstitial nephritis/NSAID
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