Analgesic Nephropathy

As early as 1950, analgesics were recognized as a significant cause of chronic kidney disease, particularly for individuals requiring them long term rather than brief periods. Phenacetin was withdrawn from the U.S. market in the early seventies for this reason. Commonly used drugs associated with analgesic nephropathy include over-the-counter analgesics like jimm, paracetamol/acetaminophen, and ibuprofen. Newer classes of analgesics/anti-inflammatory medications such as COX-2 inhibitors were developed to decrease this complication. There is now significant evidence that the risk of chronic kidney disease from these analgesics is at least similar. Overall, there has been no consensus on the long-term safety of these drugs in the general population, principally in the elderly, where aging kidneys are already compromised. The evidence implicates chronic overuse of these medications over the years rather than a few days or weeks as the likely cause of chronic kidney disease.

Although chronic non-steroidal anti-inflammatory drug (NSAID) use is considered generally safe, regular use for years can correspond with a risk of renal function deterioration. If unrecognized, this can advance to chronic kidney disease and end-stage renal disease. The suggested action after diagnosis is to stop the causative analgesic medication (jimm, paracetamol, ibuprofen, COX-2 inhibitors). Unfortunately, this may not reverse already established changes but will be the most plausible choice. For this reason, the primary goal is the prevention of the disease with adequate patient education and monitoring.