Paracetamol and analgesic nephropathy: Are you kidneying me?

Freya Waddington, Mark Naunton, Jackson Thomas, Freya Waddington, Mark Naunton, Jackson Thomas

Abstract

Introduction: Analgesic nephropathy is a disease resulting from the frequent use of combinations of analgesic medications over many years, leading to significant impairment of renal function. The observation of a large number of cases of renal failure in patients abusing analgesic mixtures containing phenacetin led to the initial recognition of the nephrotoxicity from the use of analgesics. Phenacetin was subsequently exclusively blamed for this disease. However, the role of a single analgesic as a sole cause of analgesic nephropathy was challenged, and a number of researchers have since attempted to determine the extent of involvement of other analgesics including nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, and paracetamol.

Case presentation: We present the case of an 83-year-old woman with a history of NSAID-induced nephropathy with poor pain control and reluctance to use paracetamol. We attempt to briefly review the evidence of paracetamol being implicated in the development of analgesic-induced nephropathy.

Conclusion: There is a lack of concrete data regarding causative analgesics, including paracetamol. Patients should therefore not be withheld paracetamol, an effective and commonly recommended agent, for fear of worsening renal function.

Keywords: kidney; nephropathy; paracetamol; phenacetin.

Figures

Figure 1
Figure 1
Metabolism of phenacetin to paracetamol and further metabolites.
Figure 2
Figure 2
Incidence of analgesic nephropathy (AN) in patients admitted for renal replacement therapy in New South Wales (NSW), Australia and Flanders, Belgium. Note: Republished with permission of J Am Soc Nephrol from Trends of analgesic nephropathy in two high-endemic regions with different legislation, Michielsen P, De Schepper P, 12(3):550–556, 2001; permission conveyed through Copyright Clearance Center, Inc.

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Source: PubMed

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