[Prevention of analgetics nephropathy]

Abuse of analgesics is associated with the development of renal damage which can lead to end stage renal failure. Moreover, an increased incidence of urothelial cancer is reported in abusers of analgesics. In Belgium, AN still remains a serious problem with a prevalence of 18% in dialysis patients. However AN is a preventable disease but in Belgium no adequate measurements were taken for prevention. The results of our study showed that AN is caused by the abuse of analgesic mixtures. Apart from the analgesic components, most mixtures contained caffeine. This component is considered as the principal causative agent in creating a psychic dependence to analgesics. Initially phenacetin was implicated as the nephrotoxic culprit. In recent years, however, it has become increasingly clear that phenacetin is unlikely to be the primary cause of AN. Moreover, abuse of phenacetin-containing analgesics does not exist any longer because the product is disappeared from the Belgian market. In view of the actual knowledge concerning AN, we will recommend that analgesic mixtures be put under prescription, limiting over-the-counter medication to single analgesics, in order to eliminate the occurrence of AN in Belgium.