Summary
Using an autopsy case of a 59-year-old man with analgesic nephropathy, papillary necrosis, and nephrolithiasis, it is shown that analgesic nephropathy may be complicated by damage resulting from intrarenal urine reflux. The morphologic alterations characteristic of intrarenal and/or pyelointerstitial reflux are caused by high intrapelvic pressure values during episodes of renal colic. Bacterially infected and possibly also sterile urine is then forced into the interstitium, directly within the papillary defect or indirectly via the tubular system after rupture of the tubule. The result is a severe interstitial process with inflammation, destruction, and scarring.
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References
Burry AF (1967) The evolution of analgesic nephropathy. Nephron 5:185–201
Estes RC, Brooks RT (1970) Vesicoureteral reflux in adults. J Urol 103:603–605
Gault MH, Blennerhassett J, Muehrcke RC (1971) Analgesic nephropathy. A clinico-pathologic study using electron microscopy. Am J Med 51:740–756
Gloor F (1965) Die doppelseitigen chronischen nicht-obstruktiven interstitiellen Nephritiden. Verh Dtsch Ges Path 49:92–106
Gloor F (1974) Unsere heutigen Vorstellungen über die Morphologie und Pathogenese der Analgetika-Nephropathie. Schweiz Med Wochenschr 104:785–791
Heptinstall RH, Bhagavan BS, Solez K (1979) Urinary deposits in veins and interstitium of the kidney: Their possible role in causing renal damage. In: Contr Nephrol Vol 16, Karger, Basel, pp 70–77
Hodson CJ (1979) Formation of renal scars with special reference to reflux nephropathy. In: Contr Nephrol Vol 16, Karger, Basel pp 83–89
Hutch JA, Smith DR (1969) Sterile reflux: Report of 24 cases. Urol Int 24:460–465
Kincaid-Smith P (1965) In: Kass EH (ed) Progress in Pyelonephritis. Davies & Co, Philadelphia, pp 360–361
Kincaid-Smith P, Becker G (1978) Reflux nephropathy and chronic atrophic pyelonephritis: A review. J Infect Dis 138:774–780
Lee HA, Davidson AR, Burston J (1974) Analgesic nephropathy in Wessex: a clinico-pathological survey. Clin Nephrol 2:197–207
McAninch JW, Campell PM (1973) Primary vesicoureteral reflux in adult patients. Urology 4:393–395
McGovern JH, Marshall VF (1969) Reflux and pyelonephritis in 35 adult patients. J Urol 101:668–672
Ransley PG, Risdon RA (1979) The pathogenesis of reflux nephropathy. In: Contr Nephrol Vol 16, Karger, Basel, pp 90–97
Rolleston GL, Maling TM, Hodson CJ (1974) Intrarenal reflux and the scarred kidney. Arch Dis Child 49:531–539
Servadio C, Shachner A (1970) Observations on vesicoureteral reflux and chronic pyelonephritis in adults. J Urol 103:722–726
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Laberke, H.G. The possibility of scar formation due to intrarenal reflux in analgesic nephropathy. Virchows Archiv [Pathol Anat] 394, 161–166 (1981). https://doi.org/10.1007/BF00431674
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DOI: https://doi.org/10.1007/BF00431674