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ANALGESIC NEPHROPATHY A COMMON FORM OF RENAL DISEASE IN AUSTRALIA
Author(s) -
KincaidSmith Priscilla
Publication year - 1969
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1969.tb107943.x
Subject(s) - phenacetin , renal papillary necrosis , aspirin , medicine , analgesic , acetaminophen , antipyretic , disease , nephropathy , surgery , anesthesia , kidney , pathology , endocrinology , diabetes mellitus
Analgesic nephropathy is a common form of renal disease in Australia. A characteristic form of papillary necrosis is the primary lesion in analgesic nephropathy, which is 50 times as common in Australia as it is in the United States of America. The clinical syndrome is most common in middle‐aged females. The clinical symptomatology and presentation is characteristic, and a confident diagnosis can usually be made on clinical grounds. Death from uræmia is very rare if patients are under adequate medical supervision; however, patients do die of uræmia due to papillary necrosis when this is undiagnosed, or when dehydration results from insufficient intake of salt and water. Recovery of renal function is the rule, and may continue for many years and be accompanied by considerable hypertrophy of the kidneys. Recovery occurs only if all analgesics are stopped. The condition of patients who stop taking phenacetin but continue to take aspirin and paracetamol mixtures continues to deteriorate or relapse. In experimental animals, lesions which are identical with those seen in man can be reproduced by feeding various analgesics in doses equivalent to those taken by patients, or slightly higher doses. Our experiments thus far have shown that papillary necrosis develops with aspirin‐phenacetin‐caffeine, aspirin and paracetamol, aspirin and caffeine, and aspirin alone. No papillary necrosis develops with phenacetin alone. Experiments in animals cannot be directly applied to what happens in man, but these results make it unlikely that phenacetin alone is responsible for analgesic nephropathy in man. They also explain why withdrawal of phenacetin alone is of no benefit in man. Aspirin is the only single substance with which we have been able to produce papillary necrosis. Aspirin and paracetamol (an immediate breakdown product of phenacetin) should certainly be classed with phenacetin as potential nephrotoxic agents until the exact cause of analgesic nephropathy has been established. Advertising of “over the counter” analgesics should be controlled, and they should be available only from chemists, in order to emphasize the fact that they are potentially dangerous drugs.