CHRONIC PHENACETIN NEPHROPATHY

SUMMARY Five cases of papillary necrosis are presented, four giving a history of prolonged excessive consumption of phenacetin—containing analgesic mixtures (chronic phenacetin nephropathy), the fifth in association with gout. The distribution and significance of the renal parenchymal contraction in chronic phenacetin nephropathy is discussed in relation to the medullary necrosis. It is suggested that such contraction is not due to a ”primary chronic interstitial nephritis”, but to parenchymal atrophy and fibrosis consequent upon the medullary necrosis, particularly when the latter predisposes to superimposed renal infection. In the absence of diabetes mellitus or obstructive uropathy, phenacetin abuse would appear to be the commonest cause of renal papillary necrosis and parenchymal contraction, but other conditions, including gout, may sometime produce an identical picture.