Analgesic Nephropathy

Clinical and Epidemiologic Factors
  • Thomas G. Murray


The association between the use of analgesics and the subsequent development of renal disease has been studied for more than 25 years. The causal relationship between the two has now been accepted by most students of this problem and the characteristics of the typical patient with analgesic nephropathy are known to most nephrologists and to many other physicians. There remain, however, many unanswered questions concerning this disease. Neither the precise analgesic(s) nor the daily dose or cumulative amount of the analgesic(s) that causes the renal disease is known. The proportion of individuals exposed to any given amount or type of analgesic who eventually develop analgesic nephropathy is also unknown. Of particular concern to physicians in the United States is the fact that the importance of analgesic-induced renal disease in this country is still undetermined. This chapter begins with a review of a number of widely accepted “facts” concerning analgesic nephropathy. This review will be brief, since most readers are already aware of these data and since many recent reviews of this problem exist (Kincaid-Smith 1978; T. Murray and Goldberg 1975b). The second part of this chapter is a more detailed review of available data, which deals with the magnitude of the risk of developing renal disease after the use of analgesics. The final section briefly outlines some preliminary data from an ongoing study of the importance of analgesic nephropathy in the United States.


Renal Disease Chronic Renal Disease Renal Tubular Acidosis Epidemiologic Factor Papillary Necrosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Arnold, L., Collins, C., and Starmer, G., 1976, Further studies on the acute effects of phenylbutazone, oxyphenbutazone and indomethacin in the rat kidney, Pathology 8:135.CrossRefGoogle Scholar
  2. Bengtsson V., 1962, A comparative study of chronic non-obstructive pyelonephritis and renal papillary necrosis, Acta Med. Scand. 165:321.Google Scholar
  3. Christie, D., McPherson, L., and Kincaid-Smith, P., 1976, Analgesics and the kidney: Community based study, Med. J. Aust. 2:527.Google Scholar
  4. Dubach, U., Levy, P., and Minder, F., 1968, Epidemiological study of analgesic intake and its relationship to urinary tract disorders in Switzerland, Helv. Med. Acta 34:297.Google Scholar
  5. Dubach, U., Levy, P., Posner, B., Baumela, H., Muller, A., Peier, A., and Ehrensperger, T., 1975, Relation between regular intake of phenacetin-containing analgesics and laboratory evidence of Urorenal disorders in a working female population of Switzerland, Lancet 1:539.CrossRefGoogle Scholar
  6. Furman, K., Galaska, G., and Myers, A., 1976, Post-transplantation analgesic dependence in patients who formerly suffered from analgesic nephropathy, Clin. Nephrol. 5:54.Google Scholar
  7. Gault, M., Rudwual, T., and Redman, N., 1968a, Analgesic habits of 500 veterans: Incidence and complications of abuse, Can. Med. Assoc. J. 98:619.Google Scholar
  8. Gault, M., Rudwual, T., Englis, W., and Dossetor, B., 1968b, Syndrome associated with the abuse of analgesics, Ann. Intern. Med. 68:906.Google Scholar
  9. Gillies, M., Skyring, A., and Livingstone, E., 1972, The patterns and prevalance of aspirin ingestion as determined by interview of 2,921 inhabitants of Sydney, Med. J. Aust. 1:974.Google Scholar
  10. Gonwa, T., Hamilton, R., and Bucklew, T., 1979, Importance of analgesic nephropathy (AAN) in the etiology of end-stage renal disease in Northwest North Carolina, Kidney Int. 16:930.Google Scholar
  11. Grimlund, K., 1963, Renal papillary necrosis at a Swedish factory, Acta Med. Scand. 174(S405):1.CrossRefGoogle Scholar
  12. Hussert, F., Lange, R., and Kantrow, C., 1979, Renal papillary necrosis and pyelonephritis accompanying fenoprofen therapy, J. Am. Med. Assoc. 242:1896.CrossRefGoogle Scholar
  13. Kincaid-Smith, P., 1978, Analgesic nephropathy, Kidney Int. 13:1.CrossRefGoogle Scholar
  14. Kincaid-Smith, P., 1980, Analgesic abuse and the kidney, Kidney Int. 15:250.CrossRefGoogle Scholar
  15. Koutsaimanis, K., and deWardener, H., 1970, Phenacetin nephropathy with particular reference to the effect of surgery, Br. Med. J. 4:131.CrossRefGoogle Scholar
  16. Krishaswamy, S., Wallace, D., and Nanra, R., 1974, Ischemic heart disease in analgesic nephropathy, Austral. NZ Med. J. 4:426.Google Scholar
  17. Larsen, K., and Miller, C., 1959, A renal lesion caused by abuse of phenacetin, Acta Med. Scand. 164: 53.CrossRefGoogle Scholar
  18. Lawson, D., 1973, Analgesic consumption and impaired renal function. J. Chronic Dis. 26:39.CrossRefGoogle Scholar
  19. Lindeneg, O., Fischer, S., Peterson, J., and Nissen, N., 1959, Necrosis of the renal papillae and prolonged abuse of phenacetin, Acta Med. Scand. 165:321.CrossRefGoogle Scholar
  20. Lourie, S., Denman, S., and Schroeder, E., 1977, Association of renal papillary necrosis and ankylosing spondylitis, Arth. Rheum. 20:917.CrossRefGoogle Scholar
  21. Murray, R., 1973, Dependence on analgesics in analgesic nephropathy, Br. J. Addict. 68:265.CrossRefGoogle Scholar
  22. Murray, R., Lawson, D., and Linton, A., 1971, Analgesic nephropathy: The clinical syndrome and prognosis, Br. Med. J. 1:479.CrossRefGoogle Scholar
  23. Murray, T., and Goldberg, M., 1975a, Chronic interstitial nephritis: Etiologic factors, Ann. Intern. Med. 82:453.Google Scholar
  24. Murray, T., and Goldberg, M., 1975b, Analgesic abuse and renal disease, Annu. Rev. Med. 26:537.Google Scholar
  25. Olafsson, O., Gudmundsson, K., and Brekkan, A., 1966, Migraine, gastritis and renal papillary necrosis; Acta Med. Scand. 179:121.CrossRefGoogle Scholar
  26. Sorensen, A., 1966, Is the relationship between analgesics and renal disease coincidental and not causal, Nephron 3:3366.Google Scholar
  27. Spuhler, O., and Zollinger, H. U., 1953, Die chronischinterstitielle nephritis, Z. Klin. Med. 151:1.Google Scholar
  28. Steele, T., Gyory, A., and Edwards, K., 1969, Renal function in analgesic nephropathy, Br. Med. J. 2:213.CrossRefGoogle Scholar
  29. Walters, W., Edward P., and Asschar, P., 1973, Community survey of analgesic consumption and kidney function in women, Lancet, 1:341.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1982

Authors and Affiliations

  • Thomas G. Murray
    • 1
  1. 1.Hospital of the University of PennsylvaniaPhiladelphiaUSA

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