Symposium on Analgesic Nephropathy

Kidney International (1978) 13, 15–26; doi:10.1038/ki.1978.3

Pharmacological mechanisms of analgesic nephropathy

Julian H Shelley1

1C. H. Boehringer Sohn, Bracknell, Berkshire, United Kingdom

Correspondence: Dr J H Shelley, C. H. Boehringer Sohn, Southern Industrial Estate, Bracknell, Berkshire RG12 4YS, United Kingdom.

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Abstract

The pre-Socratic philosophers were reputed to be able to entertain two mutually contradictory beliefs with apparent equanimity. In reading this review, which undoubtedly reflects the bias of the writer and, in turn, the authors of the cited works, the complexity and contradictory nature of much of the data will be evident; one cannot view, however, the result with any degree of equanimity. Much remains to be done in the experimental field before a unifying concept on the pathogenesis, incidence, and implications of analgesic nephropathy can be enunciated.

Scope of the problem. The review of Gsell [1] "From phenacetin nephritis to analgesic nephropathy" admirably reflects the change in attitude to the problem, particularly in the last ten years. Since other investigators have indicated the current scope of the problem [2–22], no further comment is needed. Adverse reactions referable to the kidney are attributed to aspirin (used alone and in combination with other agents), phenacetin (in combination), paracetamol (alone and in combination), phenylbutazone, oxyphenbutazone, ketophenbutazone, sulphinpyrazone, indomethacin, ibuprofen, ketoprofen, fenoprofen, tolmetin, glaphenine, niflumic acid, mefanamic acid, tolfenamic acid, bucloxic acid, aclofenac, and naproxen. The data used in this review are derived both from published reports and drug-monitoring committees (Table 1) [23–66]. In summary, salicylates and phenacetin used in combination and aspirin used alone are frequently implicated, the pyrazoles less so; and the newer nonsteroidal antiinflammatory agents, e.g., the phenylalkanoic acids and fenamic acids, play a small but significant part. Occasional reports implicating dextropropoxyphene, caffeine, and older analgesics are also noted.

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