NSAIDs have become the most frequent cause of drug induced renal damage in clinical practice (1)
long-term NSAID treatment may lead to the development of an analgesic nephropathy with chronic interstitial nephritis - however papillary necrosis and extra-renal features are less common (2); it has been suggested that the risk of analgesic nephropathy may be less with simple analgesic mixtures because these do not contain a habituating agent (3)
NSAIDs may, less commonly, lead to acute renal failure secondary to an acute allergic interstitial nephritis
this form of analgesic nephropathy usually results in heavy proteinuria. Occasionally there may be other features of allergy such as skin rash or eosinophilia
histology typically reveals acute interstitial inflammation and features of minimal change glomerulonephritis
NSAID-associated allergic interstitial nephritis may develop several months after the initiation of NSAID treatment. Withdrawal of the NSAID may lead to a gradual reduction in proteinuria and improvement in renal function. However full recovery may not occur
high dose steroid therapy is often used in the management of allergic interstitial nephritis
Reference:
(1) Pugliese F, Cinotti GA (1997). Nonsteroidal anti-inflammatory drugs (NSAIDs) and the kidney. Nephrol Dial Transplant, 12, 386-8.
(2) Prescribers' Journal (2000), 40 (2), 151-156.
(3) McLaughlin JK et al (1998). Analgesic use and chronic renal failure: a critical review of the epidemiological literature. Kidney Int, 54, 679-86.
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