Analgesic abuse nephropathy

This is a common cause of chronic renal failure in Europe. It is the result of chronic high intake of simple analgesics over a period of several years.

The nephropathy is characterised by chronic tubulo- interstitial nephritis and renal papillary necrosis.

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequent cause of drug induced renal damage in clinical practice (1).

Analgesic nephropathy is much more common in women than in men (2). Typically analgesic nephropathy results in chronic renal failure in late middle age.

Analgesic nephropathy is associated with an increased incidence of urothelial maligancy (1,2,3,4).

Notes (4):

• chronic analgesic nephropathy, particularly chronic interstitial nephritis and renal papillary necrosis, results from daily use for many years of mixtures containing at least two analgesics and caffeine or dependence-inducing drugs
• computed tomography scan can accurately diagnose this disease even in the absence of reliable information on previous analgesic use
• occasional to moderate regular use of aspirin and nonsteroidal anti-inflammatory drugs is without renal risk when renal function is normal
• paracetamol use is less clear although the risk is not great.
• continued use of non-phenacetin-combined analgesics with or without nonsteroidal anti-inflammatory drugs is associated with faster progression toward renal impairment.

Reference:

• Pugliese F, Cinotti GA. Nonsteroidal anti-inflammatory drugs (NSAIDs) and the kidney. Nephrol Dial Transplant 1997; 12, 386-8.
• Prescribers' Journal 2000; 40 (2): 151-156.
• Grand Round - nephrotoxicity of non-steroidal anti - inflammatory drugs, The Lancet 1994; 344: 515-8.
• De Broe ME1, Elseviers MM. Over-the-counter analgesic use. J Am Soc Nephrol. 2009 Oct;20(10):2098-103.