Is Analgesic Nephropathy a Problem in the South-West Region of Poland?

Prof. F. Kokot, Department of Nephrology, Silesian University School of Medicine, ul. Francuska 20/24, PL-40-027 Katowice (Poland) Dear Sir, The prevalence of analgesic nephropathy (AN) in hemodialyzed patients in Poland has been established as extremely low [1]. On the other hand, the existence of an inverse correlation between prevalence of AN and nephropathy of unknown etiology was shown [2]. Thus, it seems to be likely that at least in some patients with end-stage renal failure (ESRF) of unknown origin chronic uremia may be caused by the chronic abuse of analgesics. As diagnostic criteria of AN in patients with ESFR were specified only recently [3], it seemed interesting to reassess based on new diagnostic criteria the prevalence of AN in the population of the same region on which there was a previous report [1]. The present study was a part of a multi-center one coordinated by the University of Antwerp (Analgesic Nephropathy Network Europe – ANNE). In 83 patients (58 males and 25 women) admitted for the first time for dialysis treatment in 10 centers of Southern Poland from January 1991 to December 1992 the causes of chronic renal failure were analyzed. Special attention was paid to AN. In order to identify analgesic abuse we investigated regular medication during the preceding year, drug consumption for relieve of complaints such as headache or joint pains and consumption of analgesics using a book containing color photographs of analgesics sold in Poland. In all patients renal sonography and tomography were performed and searched for the presence of renal papillary calcifications, bumpy contours and decreased renal mass [3]. The mean age of examined patients was 37 years (10-60). The causes of ESRF were the following: chronic glomerulonephritis 54.3%, pyelonephritis 18.1%, polycystic disease 6%, renal vascular disease 4.8%, diabetic nephropathy 1.2%, systemic diseases 1.2% and other causes 2.4%. In 18.1% of patients the cause of chronic renal failure was unknown. In no patient could the presence of AN be proven. From results of this study it follows that AN is a rare cause of ESRF in dialyzed patients in South-West Poland. These results are concordant with those reported previously [1,4]. The reason of such low prevalence of AN in the examined population seem to be a low consumption of analgesics per capita as already reported in 1989 [1] or the relative young age of the dialysis population caused by the fact that at present only about 40% patients with ESRF are treated with renal replacement therapy in Poland. Therefore, rather young patients with a better prognosis are