Elseviers MM, DeBroe ME
A long-term prospective controlled study of analgesic abuse in Belgium

Kidney Int (Dec) 48:1912-1919 1995

The incidence of analgesic nephropathy in several european trials appears to range between 10 and 20%. A previous prospective trial published in 1991 in NEJM suggested a relative risk of 8.1 in women taking phenacetin-containing analgesics. But the risks of analgesics not containing phenacetin are less well defined. In this study a cohort of 200 active analgesic abusers from Belgium was prospectively followed for 7 years along with a cohort of 200 matched controls. All subjects were visited once a year at home for an interview and medical exam, including tests for creatine, protein, and urinalysis. Blood was analyzed for presence of salicylates and paracetamol. Median age was 53 and 77% of patients were female.

Smoking was more prevalent in abusers than controls, a possible confounding finding. Abusers tended to have higher neurotic and neurosomatic lability on psychologic testing. The serum creatinine increased in both controls (0.52 ml/min/yr) and abusers (1.12 ml/min/yr), but more quickly in abusers. 12 abusers vs. only 2 controls developed imparied renal function (CCr below 3rd percentile); all of these were taking analgesics containing at least two analgesic substances plus caffeine or codeine. The calculated relative risk for abusers was 6.1. There was no difference in urine protein/creatinine ratio in the two groups. Only 8% of abusers were taking analgesics containing phenacetin.

Comment: This study is further evidence that analgesics, even those without phenacetin, are associated with a higher relative risk of substantial renal impairment. (Daugirdas)

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Proteinuria/Hematuria : NSAIDs and other drug-induced
ARF etiology : Acute interstitial nephritis/NSAID