High diagnostic performance of CT scan for analgesic nephropathy in patients with incipient to severe renal failure

Abstract

Recently, well performing diagnostic criteria for analgesic nephropathy in end-stage renal failure (ESRF) patients were defined by the demonstration of a bilateral decrease in renal volume combined with either bumpy contours or papillary calcifications. In this study, the diagnostic value of computed tomography (CT) scan was compared to the previously used renal imaging techniques (sonography and conventional tomography). In a first study, a cohort of 40 analgesic abusers (defined as daily use of analgesic mixtures during at least 5 years) and 40 controls, all ESRF patients without a clear renal diagnosis, were investigated with sonography, tomography and CT scan without injection of iodinated contrast material, to search for the imaging signs of analgesic nephropathy. Using CT scan, sonography and tomography, renal size could be evaluated with comparable results while CT scan was superior in the detection of papillary calcifications (sensitivity 87%, specificity 97%). In a second controlled study of 53 analgesic abusers with a serum creatinine between 1.5 to 4 mg/dl in the absence of a clear renal diagnosis, a CT scan was performed and scored for the presence of decreased renal volume, bumpy contours and papillary calcifications. It was found that the renal image of analgesic nephropathy on CT scan in an early stage of renal failure is comparable with the observations made in ESRF patients. Particularly the demonstration of papillary calcifications showed a high sensitivity of 92% with a specificity of 100% for the early diagnosis of analgesic nephropathy.

Non–Contrast-Enhanced Computerized Tomography and Analgesic-Related Kidney Disease

“…There are several potential explanations for the lower prevalence of analgesic-related findings on CT scans in our study versus the earlier work by Elseviers, DeBroe, and colleagues (2,12,13,17). The ingested drugs differ, with little phenacetin or analgesic mixture use among US patients as compared with Belgian patients.…”

“…Our results demonstrate that findings of SICK do not occur with sufficient frequency in US patients with ESRD and heavy analgesic exposure to render the non-contrast-enhanced CT scan a sensitive tool to identify such individuals, as proposed by Elseviers and colleagues (12,13,17,18). Although the conclusion concerning the lack of diagnostic value of the CT scan is clear despite the relatively small numbers, we stress that NANS did not address the overall relationship between analgesics and the progression of renal disease.…”

“…Furthermore, the total number of patients who met the criteria for SICK in this study is small in both absolute and relative terms. Overall, 15 patients were identified with SICK, and only four patients met the criteria described by Elseviers, Debroe, and colleagues (2,12,13,17). The patients with SICK represented approximately 7% of the entire series, which in turn represented approximately one seventh of all patients with ESRD.…”

“…Our aim was to develop a more quantitative and stringent definition of the criteria of Elseviers et al (12,13) using the higher resolution helical CT scanning technique and improved methods of renal volume analysis. The "DeBroe" criteria included bilaterally small kidneys (based on an unusual method of renal size determination that consisted of summing the anterior-posterior and lateral dimensions as seen on the axial CT slice closest to the hilum) plus three or more indentations on the CT slice with the most contour changes and/or calcifications seen along the papillary line.…”

Graphene Oxide/Ag Nanoparticles Cooperated with Simvastatin as a High Sensitive X‐Ray Computed Tomography Imaging Agent for Diagnosis of Renal Dysfunctions

“…[48] The diagnosis methods of kidney www.advancedsciencenews.com www.advhealthmat.de disease include biopsy of IgAN, determination of CysC and BUN in serum, ultrasonography, intravenous pyelography, and CT imaging and so on. [49,50] Compared with biopsy and blood test, renal imaging investigations demonstrating a decrease in length of both kidneys combined with either bumpy contours or signs of renal papillary necrosis showed a high sensitivity and specificity for diagnosing the disease. X-ray imaging is used in intravenous pyelography and CT imaging, but with the development of multislice CT scan, CT imaging is becoming more and more important in the detection of nephropathy.…”