intravenous urography - this will demonstrate established papillary necrosis if present - this test is less used than previously
computerised tomography - this is said to be the most sensitive test for papillary necrosis (1)
however a study of patients with ESRD (National Analgesic Nephropathy Study [NANS]) in the United States evaluated the value of the non-contrast-enhanced CT as diagnostic test for AN
in this study the sensitivity of the noncontrast CT scan for the detection of analgesic-associated kidney injury was too low to be used as a routine test (3)
Reference:
1) Elseviers MM, Waller I, Nenoy D et al. Evaluation of diagnostic criteria for analgesic nephropathy in patients with endstage renal failure: results of the ANNE study. Nephrol Dial Transplant 1995;10: 808-814.
2) Prescribers' Journal 2000; 40 (2): 151-156
3) Henrich WL, Clark RL, Kelly JP, Buckalew VM, Fenves A, Finn WF, Shapiro JI, Kimmel PL, Eggers P, Agodoa LE, Porter GA, Shapiro S, Toto R, Anderson T, Cupples LA, Kaufman DW : Non-contrast-enhanced computerized tomography and analgesic-related kidney disease: Report of the national analgesic nephropathy study. J Am Soc Nephrol 2006; 17: 1472-1480
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