Analgesic abuse and the kidney

Abstract

This 66-year-old man was diagnosed as having Guillain-Barre syndrome 32 years ago. Because of back pain from residual arachnoiditis. he began to take approximately 12 tablets of Percodan® per day. Slight proteinuria and a blood urea nitrogen of 25 mg/dl were discovered 17 years ago when he was hospitalized for treatment of a gastric ulcer. He was hospitalized 14 years ago because of fatigue, anemia, and azotemia. The physical examination was unremarkable: blood pressure was 140/80mm Hg, blood urea nitrogen was 60 mg, and serum creatinine was 6.2 mg/ dl. A gastric ulcer was demonstrated on an upper GI series but had healed by repeat examination several weeks later. By this time the patient's accumulated phenacetin intake was estimated to be 5 to 7kg, and on the advice of his physician he discontinued all further ingestion of phenacetin-containing analgesics. Laminagrams revealed symmetrical kidneys measuring 11.5 to 12 cm in length. Retrograde pyelography revealed no evidence of obstruction or papillary necrosis. Urine culture grew Pseudomonas aeruginosa, and a course of colistin therapy was given. Serum creatinine concentration rose from the admission level of 6.2 mg to 10.2 mg, but fell to 7.7 mg/dl by the time of discharge. The rise in serum creatinine occurred 5 to 7 days after the colistin was discontinued. Six months later, the patient was hospitalized for fever, chills, and acute left flank pain due to obstruction from a presumed ne-