Renal parenchymal disease related to over-the-counter analgesic use

The occurrence of parenchymal renal disease has been attributed in many case reports to heavy use of over-the-counter (OTC) analgesics. To quantify this putative relationship, we carried out a comprehensive case history review of newly diagnosed parenchymal renal disease requiring hospitalization among patients who ever used acetaminophen, aspirin, or ibuprofen, at Group Health Cooperative of Puget Sound. During the 6-year period 1984-1989, 17 cases of newly diagnosed, unexplained renal disease were identified among the 378,769 users of OTC analgesics, among whom 26,931 filled at least 20 prescriptions for the analgesics studied. Six of the 17 were possibly attributable to outpatient drug use. Of these, OTC analgesics were suspected clinically as a possible causal factor in two, but in both patients other causes seemed equally likely. We did not find any patients with anatomic or pathologic findings associated with analgesic nephropathy. We conclude that parenchymal renal disease attributable to OTC analgesic use and requiring hospitalization is a rare occurrence.