Chromic Renal Failure Due to Drugs



A common form of end-stage renal disease is that related to the long-term ingestion of analge­sics, particularly drug combinations containing aspirin and phenacetin. The prototypic patient is one with long-standing complaints of chronic pain such as headache or backache. There may be a history of peptic ulcer disease. There is usually a history that indicates ingestion of analgesics in kilogram amounts over a period of years. Obtain­ing the drug history may be difficult owing to the personalities of such patients and because aspirin and aspirin-containing drugs are not considered medications by some individuals. The pathogen­esis of analgesic abuse nephropathy is uncertain but is likely related to the fact that the aspirin component decreases total and papillary blood flow to the kidney and phenacetin metabolites ac­cumulate in the interstitium and papillae. The in­cidence of analgesic abuse nephropathy varies widely among different countries and among dif­ferent regions of the same country. The reasons for these differences are unknown. The clinical presentation is that of renal insufficiency and hy­pertension. Some patients manifest papillary ne­crosis. Histological examination of the kidney re­veals interstitial fibrosis and atrophy of tubules. It has been suggested that the deterioration in renal function may be slowed or reversed when the drugs are stopped. Since there are no specific characteristics of this disease entity, a strong clin­ical suspicion and a careful drug history are man­datory.