Progression of Renal Failure in Analgesic-Associated Nephropathy
作者:
Anke Schwarz,
Ulrich Kunzendorf,
Frieder Keller,
Gerd Offermann,
期刊:
Nephron
(Karger Available online 1989)
卷期:
Volume 53,
issue 3
页码: 244-249
ISSN:1660-8151
年代: 1989
DOI:10.1159/000185752
出版商: S. Karger AG
关键词: Analgesic nephropathy;Progression of renal failure;Acetaminophen;Papillary necrosis
数据来源: Karger
摘要:
The factors that influence the progression of renal failure in analgesic-associated nephropathy (AAN) still remain to be clarified. In this study, the actual analgesic intake (N-acetyl-p-aminophenol, NAPAP, i.e. acetaminophen in urine) and progression of renal failure (1/crea method) in 127 outpatients with various renal diseases were investigated over a period of 7–150 months. AAN was diagnosed in 57 of the 127 patients (44%). The NAPAP test was positive in 21% of the 57 AAN patients and in 3% of the 70 control patients with other renal diseases (p = 0.0001). The AAN patients presented with more advanced renal insufficiency, lost more weight, and had more severe hypertension as well as a higher mortality rate than the control patients (univariate analysis). Progression of renal insufficiency, as measured by regression analysis of the reciprocal of serum creatinine versus time and expressed as clearance loss per year, was more rapid in the AAN patients who were found positive for NAPAP (6.9 ± 5.5 ml/min/year) than in the AAN patients who were found negative (4.1 ± 11.0 ml/min/year) or in control patients with other renal diseases (5.1 ± 14.9 ml/min/year). Multivariate analysis showed the more rapid clearance loss to be the most discriminating factor between the AAN patients who continued analgesic abuse of phenacetin- or acetaminophen-containing drugs and AAN patients who stopped. We therefore conclude that continued analgesic abuse promotes renal insufficiency in AAN. The progression of renal failure in AAN patients who stopped abusing analgesics, however, cannot be explained within the parameters investigated, i.e. urinary tract infection, hypertension, hyperalimentation, or papillary necr
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