Figure 618

Computed tomography (CT) imaging criteria for diagnosing analgesic nephropathy. Renal size (A) is considered decreased if the sum of a and b (panels A and B) is less than 103 mm in men and 96 mm in women. Bumpy contours are considered to be present if at least three indentations are evident (panels B and C). The scan can reveal papillary calcifications (panels B and D). Visual observation of the configurational changes illustrated in Figure 6-18 can be extremely useful in diagnosing the scarred kidney in analgesic nephropathy. A series of careful studies using CT scans without contrast material have provided imaging criteria for the diagnosis of analgesic nephropathy. Validation of these criteria currently is underway by a study at the National Institutes of Health.

From studies comparing analgesic abusers to persons in control groups, it has been shown that a decrease in kidney size and bumpy contours of both kidneys provide a diagnostic sensitivity of 90% and a specificity of 95%. The additional finding of evidence of renal papillary necrosis provides a diagnostic sensitivity of 72% and specificity of 97%, giving a positive predictive value of 92%. RA— renal artery; RV— renal vein. (From DeBroe and Elseviers [6]; with permission.)

Female predominance, 60-85% Age, >30 y

Personality disorders: introvert, dependent, anxiety, neurosis, family instability

Addictive habits: smoking, alcohol, laxatives, psychotropics, sedatives

Causes of analgesic dependency: headache, 40-60%; mood, 6-30%; musculoskeletal pain, 20-30%

0 0

Post a comment