Analgesic nephropathy
Meaning of analgesic nephropathy: For the purposes of this Statement of Principles, analgesic nephropathy: means a bilateral chronic renal disease characterised by papillary necrosis, chronic interstitial nephritis, renal cortical atrophy and capillary sclerosis, and a clinical state of loss of renal function in an individual with a history of consumption of large amounts of analgesic agents, occurring in the absence of another biochemical, anatomical or metabolic cause for renal impairment. (3) While analgesic nephropathy attracts ICD-10-AM code N14.0, in applying this Statement of Principles the meaning of analgesic nephropathy is that given in subsection (2). (4) For subsection (3), a reference to an ICD-10-AM code is a reference to the code assigned to a particular kind of injury or disease in The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM), Tenth Edition, effective date of 1 July 2017, copyrighted by the Independent Hospital Pricing Authority, ISBN 978-1-76007-296-4.
Reasonable Hypothesis (RH) — Statement of Principles No. 43 of 2025
At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting analgesic nephropathy or death from analgesic nephropathy with the circumstances of a person's relevant service:
- (1)Consuming: (a) a total of at least 1 kg of phenacetin in a phenacetin-containing analgesic before clinical onset; or (b) an average of at least 1 g/day of phenacetin in a phenacetin- containing analgesic for a continuous period of at least 2 years immediately preceding clinical onset;
Note: Phenacetin is an aniline derivative drug with analgesic and antipyretic properties. It was a constituent of over-the-counter compound analgesic medications including Bex powder, Vincent's powder, Empirin Compound, and Bromo seltzer.
Note: Phenacetin is also known as acetophenetidin, aceto-p-phenetidide, acetylphenetidin, phenacetinum, N-(4-ethoxyphenyl) acetamide, p-ethoxyacetanilide, or CAS 62-44-2.
- (2)inability to obtain appropriate clinical management for analgesic nephropathy before clinical worsening;
Aggravation-only factors: the factors in subsection 9(2) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
Balance of Probabilities (BoP) — Statement of Principles No. 44 of 2025
2 factors
At least one of the following factors must exist before it can be said that, on the balance of probabilities, analgesic nephropathy or death from analgesic nephropathy is connected with the circumstances of a person's relevant service:
- (1)Consuming: (a) a total of at least 1 kg of phenacetin in a phenacetin-containing analgesic before clinical onset; or (b) an average of at least 1 g/day of phenacetin in a phenacetin- containing analgesic for a continuous period of at least 2 years immediately preceding clinical onset;
Note: Phenacetin is an aniline derivative drug with analgesic and antipyretic properties. It was a constituent of over-the-counter compound analgesic medications including Bex powder, Vincent's powder, Empirin Compound, and Bromo seltzer.
Note: Phenacetin is also known as acetophenetidin, aceto-p-phenetidide, acetylphenetidin, phenacetinum, N-(4-ethoxyphenyl) acetamide, p-ethoxyacetanilide, or CAS 62-44-2.
- (2)inability to obtain appropriate clinical management for analgesic nephropathy before clinical worsening;
Aggravation-only factors: the factors in subsection 9(2) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
