Renal papillary necrosis analgesic abuse

Renal papillary necrosis with retroperitoneal fibrosis secondary to analgesic abuse (involving aspirin, propoxyphene, and numerous other analgesics taken in large quantities for many years) has also incidentally been reported (SEDA-7, 94). 

Abuse and misuse of analgesics continues to be a major problem in many countries (1 -7 ), Apart from the psychosocial problems of analgesic abuse, there are important medical complications which may lead to the death of the patient (3 ). These complications include chronic anaemia, peptic ulceration, and renal papillary necrosis with progressive renal failure. Analgesic abuse is often not recognized by doctors, and patients may go to considerable lengths to conceal their habit (7 ). 

There have been further clinical reports of renal papillary necrosis and chronic renal failure in patients abusing analgesic mixtures containing phenacetin (5, 7, 8, 142 — 146, 158 ). However, many authors persist in referring incorrectly to phenacetin abuse , and phenacetin nephritis (155, 193 — 197<, 198, 199 ). 

Paracetamol has been suspected as an aetiological agent in analgesic nephropathy (5 ), but no properly authenticated case of renal papillary necrosis has been reported in which paracetamol was the only analgesic abused. 

Clinical evidence linking the abuse of analgesic mixtures with the development of renal failure was well documented from the I960 s on. There are numerous reports demonstrating a high incidence of heavy analgesic consumption in patients with renal failure or papillary necrosis [14]. Also the observed deterioration of renal function in patients with analgesic nephropathy who continued their abuse, and in contrast the stabilization of renal function after discontinuation of the abuse, is in favor of this association [29-32]. 

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