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