The Clinical Syndrome of Analgesic Abuse

The precise role of phenacetin, its metabolites, associated impurities, and fellow travelers, aspirin and caffeine, in producing interstitial nephritis remains to be clearly defined.1,2Despite continuing disagreement regarding the pathogenesis of the renal disease, it is clear that abuse of analgesic compounds is associated with a high incidence of chronic interstitial nephritis or pyelonephritis or both and in many instances with papillary necrosis as well.3-6 Gsell and co-workers2have described the clinical picture of analgesic nephropathy, stressing the physiological consequences of insidiously progressive renal failure. Other writers have focused upon the situations in which analgesic abuse is found to occur5,7,8or upon some of the associated clinical findings of the syndrome. Noteworthy is the common occurrence of migraine headache,5gastritis and peptic ulcer,5,7,9anemia,4and psychiatric disease.4,10These and other features of the clinical syndrome of analgesic abuse have recently been reviewed