Symposium on Analgesic Nephropathy

Kidney International (1978) 13, 72–78; doi:10.1038/ki.1978.10

Analgesic abuse and renal failure in Australasia

John H Stewart1

1Medical Research Department, Kanematsu Memorial Institute, Sydney Hospital, Sydney, Australia

Correspondence: Dr J H Stewart, Medical Research Department, Sydney Hospital, Sydney, N.S.W. 2000, Australia.

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Abstract

Analgesic-induced renal papillary necrosis first became a significant factor in mortality tables for two Australian states, Queensland and New South Wales, about the year 1960 [1, 2], and the earliest descriptions of the clinical syndrome and renal pathology in Australasia (i.e., Australia and New Zealand) appeared during the following two years [3–5]. Nearly two decades earlier there had been a sharp increase in the prevalence of chronic gastric ulcer in young women living in the same two states [6–9], but the etiological role of analgesic abuse in that disease was not recognized until the 1960's [ 10–15]. Analgesic-induced nephropathy and gastric ulcer are still common in our community, representing the most serious elements of what has been termed in Australia "the analgesic syndrome". Their combined morbidity and mortality place minor analgesics fourth only to alcohol, tobacco, and sedatives in the table of our most harmful addictive drugs [16, 17].

It is the purpose of this review to describe the extent and pattern of non-narcotic analgesic abuse in Australasia and the prevalence of end-stage renal disease due to papillary necrosis. Preventive measures which have been introduced or proposed in this region are also discussed.

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