title: Non-contrast-enhanced computerized tomography and analgesic-related kidney disease: report of the national analgesic nephropathy study.
abstract: Previous studies suggested that the non-contrast-enhanced computerized tomography (CT) scan is a highly reliable tool for the diagnosis of analgesic-associated renal disease. However, this issue has not been addressed in the US population. A total of 221 incident patients with ESRD from different regions of the United States underwent a helical CT scan and detailed questioning about drug history. Specific renal anatomic criteria were developed to determine whether a constellation of CT findings (small indented calcified kidneys [SICK]) is linked to analgesic ingestion. For approximating use before the onset of renal disease, only analgesic ingestion at least 9 yr before starting dialysis was considered relevant. Fifteen patients met the criteria for SICK. This represented 7% of the enrolled patients and approximately 1% of the total ESRD population. There was a significant increase in the estimated risk among patients with a history of heavy aspirin ingestion (odds ratio [OR] 7.4 [95% confidence interval (CI) 1.2 to 43] for > or =1 kg lifetime; OR 8.8 [95% CI 1.2 to 66] for > or =0.3 kg/yr). Total analgesic ingestion of > or =0.3 kg/yr also was significantly associated with SICK (OR 8.2; 95% CI 1.5 to 45). These findings were accounted for largely by combination products that contained aspirin and phenacetin (used by three patients with SICK), which are no longer available. In addition, the CT finding of SICK was present only in a minority of heavy analgesic users, yielding a sensitivity of 5 to 26%. Findings of SICK are infrequent in the US ESRD population and do not occur among a sufficient proportion of heavy analgesic users to render the non-contrast-enhanced CT scan a sensitive tool to detect analgesic-associated kidney injury.
authors.affiliation: Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA. henrich@uthscsa.edu
authors.forename: William L
authors.initials: WL
authors.lastname: Henrich
authors.forename: Richard L
authors.initials: RL
authors.lastname: Clark
authors.forename: Judith P
authors.initials: JP
authors.lastname: Kelly
authors.forename: Vardaman M
authors.initials: VM
authors.lastname: Buckalew
authors.forename: Andrew
authors.initials: A
authors.lastname: Fenves
authors.forename: William F
authors.initials: WF
authors.lastname: Finn
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Shapiro
authors.forename: Paul L
authors.initials: PL
authors.lastname: Kimmel
authors.forename: Paul
authors.initials: P
authors.lastname: Eggers
authors.forename: Larry E
authors.initials: LE
authors.lastname: Agodoa
authors.forename: George A
authors.initials: GA
authors.lastname: Porter
authors.forename: Samuel
authors.initials: S
authors.lastname: Shapiro
authors.forename: Robert
authors.initials: R
authors.lastname: Toto
authors.forename: Theresa
authors.initials: T
authors.lastname: Anderson
authors.forename: L Adrienne
authors.initials: LA
authors.lastname: Cupples
authors.forename: David W
authors.initials: DW
authors.lastname: Kaufman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics; D003287:Contrast Media; D003956:Dialysis / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology
chemical_list: D000700:Analgesics; D003287:Contrast Media