Analgesic nephropathy and the use of nonsteroidal anti-inflammatory drugs in renal patients: new insight.

Analgesic-associated nephropathy due to analgesic mixtures and possibly due to nonsteroidal anti-inflammatory drugs taken over long periods of time represent a preventable cause of chronic renal failure. The exact prevalence of this condition in various countries around the world is still unclear almost 30 years after the original description of this entity. With the advent of specific diagnostic criteria, the prevalence should become much more clear by studying dialysis populations and other patients with chronic renal disease prior to end stage. The effect of analgesics and nonsteroidal drugs on renal disease of other established etiologies is not well-characterized either. Just as blood pressure control is essential in prolonging the course of chronic renal failure, the use of these NSAIDs may be a risk factor for accelerating such clinical courses. It is of interest that recent preliminary epidemiologic data suggest that prolonged and heavy use of illicit drugs can also be a risk factor for chronic renal disease (personal communication). Such risk factors are compatible with a public health approach towards prevention of a disease state in which expensive resources are necessary and for which the affected population is growing at alarming rates worldwide. Pharmaceutical manufacturers should be required to conduct properly controlled safety studies for long-term effects of compounds, particularly when they are to be released for over-the-counter consumption and are to be heavily marketed.