Symposium on Analgesic Nephropathy

Kidney International (1978) 13, 64–71; doi:10.1038/ki.1978.9

Analgesic-associated nephropathy in the U.S.A.: Epidemiologic, clinical and pathogenetic features

Thomas G Murray1 and Martin Goldberg1

1Department of Medicine, Renal-Electrolyte Section, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Correspondence: Dr T G Murray, Department of Medicine, Renal-Electrolyte Section, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, U.S.A.

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Abstract

The original suggestion that an association exists between the ingestion of large amounts of analgesics and the development of interstitial nephropathy was made in 1953 [1]. Since that time, many hundreds of cases illustrating this association have been reported from around the world [2, 3]. Presently, most authors refer to the renal disease which develops in patients who consume large amounts of analgesics as analgesic "abuse" nephropathy. There are, however, in our opinion, a number of disadvantages to the use of the word "abuse" in that designation. The major disadvantage lies in the judgmental nature of the word abuse. This word implies that something about the patients' use of analgesics is consciously inappropriate. There are, however, no data to support this implication. As we will discuss subsequently, it is not proven that only doses of analgesics beyond those prescribed by physicians or needed for relief of pain are associated with the development of renal disease. We, therefore, prefer to refer to this entity as analgesic "associated" nephropathy (AAN); and we will do so throughout this paper.

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References

  1. Spühler V, Zollinger H: Die chronisch: Interstitialle Nephritis. Z Klin Med 151:1–50, 1953
  2. Shelley J: Phenacetin, through the looking glass. Clin Pharmacol Ther 8:427–471, 1967
  3. Abel J: Analgesic nephropathy: A review of the literature, 1967-70. Clin Pharmacol Ther 12:583–598, 1971
  4. Gault M, Ruduol T, Engles W, Dosseter J: Syndrome associated with the abuse of analgesics. Ann Intern Med 68:906–925, 1968
  5. Fellner S, Tuttle E: The clinical syndrome of analgesic abuse. Arch Intern Med 124:379–382, 1969
  6. Murry T, Goldberg M: Chronic interstitial nephritis: Etiologic factors. Ann Intern Med 82:453–459, 1975
  7. Maher J: Toxic nephropathy, in The Kidney, edited by Brenner B, Rector F, Philadelphia, W. B. Seiunders Co., 1976, pp. 1358–1361
  8. Schreiner G: The nephrotoxicity of analgesic abuse. Ann Intern Med 57:1047–1052, 1962
  9. Mudge G: Synposium on mechanisms of nephropathy: Analgesics. Proc Am Soc Nephrol, 9th Annual Meeting, Washington, D.C., 1976
  10. Murray T, Goldberg M: Analgesic abuse and renal disease. Ann Rev Med 26:537–550, 1976
  11. DePalma J, Wassanmiller J, Abukurah A: Phenacetin/aspirin nephritis as a cause of chronic renal failure. Western Dialysis and Transplant Society Meeting, Las Vegas, Nevada, 1975
  12. Lawson D: Analgesic consumption and impaired renal function. J Chron Dis 26:39–45, 1973
  13. Murray R, Lawson D, Linton A: Analgesic nephropathy: Clinical syndrome and prognosis. Br Med J 1:479–482, 1971
  14. Gault M, Blennenhassalt J, Muehrcke R: A clinicopathologic study using electron microscopy. Am J Med 51:740–756, 1971
  15. Gault M, Rudwal T, Redmond N: Analgesic habits of 500 veterans: Incidence and complications of abuse. Can Med Assoc J 98:619–624, 1968
  16. Schreiner G: Progress in Pyelonephritis, edited by KASS E, Philadelphia, Davis, 1975, p. 347
  17. Olafsson O, Gudmundsson K, Brekkan A: Migraine, gastritis and renal papillary necrosis: A syndrome in chronic nonobstructive pyelonephritis. Acta Med Scand 179:121–128, 1966
  18. Murray R, Lawson D, Linton A: Analgesic nephropathy: Clinical syndrome and prognosis. Br Med J 1:479–482, 1971
  19. Prescott L: Analgesic abuse and renal disease in North-Eastern Scotland. Lancet 2:1143–1145, 1966
  20. Nordenfelt O, Ringentz N: Phenacetin takers dead with renal failure. Acta Med Scand 770:385–402, 1961
  21. Arger P, Bluth E, Murray T, Goldberg M: Analgesic abuse nephropathy. Urology 7:123–128, 1976
  22. Liu T, Smith G, Rankin J: Renal pelvic tumors associated with analgesic abuse. Can Med Assoc J 107:768–771, 1972
  23. Hoybye G, Nielsen O: Renal pelvic carcinoma in phenacetin abuse. Scand J Urol Nephrol 5:190–193, 1971
  24. MacGregor G, Jones N, Baraclough M, Wing A, Cranston W: Ureteric stricture with analgesic nephropathy. Br Med J 2:271–272, 1973
  25. New Zealand Rheumatism Association Study: Aspirin and the kidney. Br Med J 1:593–596, 1974
  26. Krikler D: Paracetanol and the kidney. Br Med J 2:615–616, 1967
  27. Linton A: Recognition of the problem of analgesic nephropathy. Can Med Assoc J 107:746–748, 1972
  28. Kincaid-Smith P: Pathogenesis of the renal design associated with the abuse of analgesics. Lancet 1:859–862, 1967
  29. Burry A: The evolution of analgesic nephropathy. Nephron 5:185–201, 1967
  30. Fordham C, Huffines W, Welt L: Phenacetin-induced renal disease in rats. Ann Intern Med 62:738–743, 1965
  31. Claussan E: Histological changes in rabbit kidneys induced by phenacetin and acetylsalicylic acid. Lancet 2:123–124, 1964
  32. Nanra R, Kincaid-Smith P: International Symposium on Problems of Analgesic Abuse, edited by Hasdale H, Vienna, Factor Publ., 1973, pp. 67–88
  33. Nanra R, Kincaid-Smith P: Papillary necrosis in rats caused by aspirin containing mixtures. Br Med J 3:559–561, 1970
  34. Abraham E, Rubenstein A, Levin N: Phenacetin-induced papillary damage in experimental animals. Nature 200:695–696, 1963 | Article |
  35. Sakan B, Kincaid-Smith P: Papillary necrosis in experimental analgesic nephropathy. Br Med J 1:161–162, 1969
  36. Goldberg M, Myers C, English P, Peschel W: The mechanism of analgesic abuse nephropathy (abstr.). J Clin Invest 47:27a, 1971
  37. Bluemle L, Goldberg M: Renal accumulation of salicylide and phenacetin: Possible mechanisms in the nephropathy of analgesic abuse. J Clin Invest 47:2507–2513, 1965
  38. Duggin G, Mudge G: Analgesic nephropathy: Renal distribution of acetaminophen and its conjugates. J Pharmacol Exp Ther 199:1–9, 1976
  39. Gault M: Demonstration of an intrarenal gradient for C14-acetylsalicylic acid in rabbits and guinea pigs, in Proc Am Soc Nephrol 4th Annual Meeting, November, 1970, p. 28
  40. Quintanilla A, Kessler R: Direct effects of salicylate in renal function in the dog. J Clin Invest 52:3143–3153, 1973
  41. Shadhidi N, Westring D: Acetylsalicylic acid-induced hemolysis and its mechanism. J Clin Invest 49:1334–1340, 1970

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