Aetiology

Analgesic abuse nephropathy has been linked with chronic high intake of the following drugs:

• paracetamol (acetaminophen)
• phenacetin - this drug was withdrawn in 1966
• aspirin

However non-steroidal anti-inflammatory drugs (NSAIDs) have become the most common cause of drug induced damage in clinical practice (1).

Narcotic analgesics are not directly nephrotoxic and therefore do not themselves result in analgesic-induced renal damage (2).

Caffeine is also found in many preparations. This agent and similar centrally acting agents may promote habituation and lead to the consumption of increasing doses of analgesics (3).

Notes (4):

• chronic analgesic nephropathy, particularly chronic interstitial nephritis and renal papillary necrosis, results from daily use for many years of mixtures containing at least two analgesics and caffeine or dependence-inducing drugs
• computed tomography scan can accurately diagnose this disease even in the absence of reliable information on previous analgesic use
• occasional to moderate regular use of aspirin and nonsteroidal anti-inflammatory drugs is without renal risk when renal function is normal
• paracetamol use is less clear although the risk is not great.
• continued use of non-phenacetin-combined analgesics with or without nonsteroidal anti-inflammatory drugs is associated with faster progression toward renal impairment.

Reference:

• Pugliese F, Cinotti GA. Nonsteroidal anti-inflammatory drugs (NSAIDs) and the kidney. Nephrol Dial Transplant 1997; 12:386-8.
• Prescribers' Journal 2000; 40 (2): 151-156.
• McLaughlin JK et al. Analgesic use and chronic renal failure: a critical review of the epidemiological literature. Kidney Int 1998;54:679-86.
• De Broe ME1, Elseviers MM. Over-the-counter analgesic use. J Am Soc Nephrol. 2009 Oct;20(10):2098-103.