Analgesic nephropathy: Etiology, clinical syndrome, and clinicopathologic correlations in Australia

The abuse of analgesics in the Australian community and its role in disease of the heart and alimentary canal has been recognized since 1907 [1] when it was noted that “what the drink habit is among men in Australia, the headache powder is among women.” The initial reports of analgesic nephropathy from Australia appeared in the early 1960's [2–5], almost ten years after Spühler and Zollinger in 1953 [6] drew attention to the association between abuse of phenacetin-containing compounds and a form of renal disease characterized by renal papillary necrosis (RPN) and chronic interstitial nephritis. The habit of analgesic abuse and the serious consequences of renal disease and renal failure is a major public health problem in the Australian community. Between 4.6% and 45.1% of different sub-populations in the community consume analgesics daily, often for inappropriate reasons [7–16]. At the Royal Newcastle Hospital, 407 patients with analgesic nephropathy have presented over four years. This represents a third of all patients presenting to the renal unit. In Australia, analgesic abuse causes terminal renal failure in 20% of those treated by dialysis and transplantation [17], compared to 5.5% in Canada [19] and 3.1% in Europe [20]. In the U.S.A., analgesic nephropathy was found to be responsible for 7% of chronic renal disease in one survey [18]. The autopsy incidence of RPN in major Australian hospitals is between 3.6 and 20% [2,21–25] and is much higher than that reported from elsewhere in the world (0.1 to 4%) [27–35].