Analgesic nephropathy overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]
Overview
The term analgesic nephropathy usually refers to damage induced by excessive use of combinations of these medications, specifically combinations that include phenacetin. For this reason, it is also called analgesic abuse nephropathy. Others prefer the less judgmental analgesic-associated nephropathy. Both terms are abbreviated to the acronym AAN, by which the condition is also commonly known.
Analgesic nephropathy is injury to the kidney caused by analgesic medications such as aspirin, phenacetin, and paracetamol. The term usually refers to damage induced by excessive use of combinations of these medications, especially combinations that include phenacetin. It may also be used to describe kidney injury from any single analgesic medication.
The specific kidney injuries induced by analgesics are renal papillary necrosis and chronic interstitial nephritis. They appear to result from decreased blood flow to the kidney, rapid consumption of antioxidants, and subsequent oxidative damage to the kidney. This kidney damage may lead to progressive chronic renal failure, abnormal urinalysis results, high blood pressure, and anemia. A small proportion of individuals with analgesic nephropathy may develop end-stage kidney disease.
Analgesic nephropathy was once a common cause of kidney injury and end-stage kidney disease in parts of Europe, Australia, and the United States. In most areas, its incidence has declined sharply since the use of phenacetin fell in the 1970s and 1980s.
Overview
Historical Perspective
In 1953, the association between analgesic drugs and chronic renal disease was first reported in German.[1] In 1977, phenacetin became legally banned in Australia.[2] In 1978 and 1983, phenacetin was withdrawn from the Canadian and US markets, respectively.[3][4]
Epidemiology and Demographics
There is insufficient evidence about the incidence, prevalence and racial predilection of analgesic nephropathy. Most patients with analgesic nephropathy have been reported to be middle age or older with a history of chronic pain.[5] There is insufficient evidence that suggests gender predilection in analgesic nephropathy. However, some studies suggest that analgesic nephropathy is more conman in females than males.[6]
References
- ↑ Spühler O, Zollinger HU (1953). "Die chronisch-interstitielle Nephritis". Z Klin Med (in German). 151 (1): 1–50. PMID 13137299.
- ↑ Michielsen P, de Schepper P (2001). "Trends of analgesic nephropathy in two high-endemic regions with different legislation". J Am Soc Nephrol. 12 (3): 550–6. PMID 11181803.
- ↑ "Some pharmaceutical drugs". IARC Monogr Eval Carcinog Risk Chem Hum. 24: 1–337. 1980. PMID 6937434.
- ↑ "List of drug products that have been withdrawn or removed from the market for reasons of safety or effectiveness. Food and Drug Administration, HHS. Final rule". Fed Regist. 64 (44): 10944–7. 1999. PMID 10557618.
- ↑ Yaxley J (2016). "Common analgesic agents and their role in analgesic nephropathy: A commentary of the evidence". Int J Risk Saf Med. 28 (4): 189–196. doi:10.3233/JRS-170735. PMID 28582877.
- ↑ Gault MH, Wilson DR (1978). "Analgesic nephropathy in Canada: clinical syndrome, management, and outcome". Kidney Int. 13 (1): 58–63. doi:10.1038/ki.1978.8. PMID 713269.