Evidence for the nephrotoxicity of analgesics

Analgesic nephropathy in man is a definite but complex and probably multifactorial disorder, which largely follows long-term abuse of mixed analgesics. In North America the disorder has been almost entirely associated with heavy ingestion of the combination acetylsalicylic acid (ASA), phenacetin and caffeine. There is less clinical and experimental evidence for the nephrotoxicity of single analgesics; however, evidence for the nephrotoxicity of ASA alone is greater than that for phenacetin. In view of the evidence for nephrotoxicity of most mild analgesics, removal of phenacetin from the market would be unlikely to eliminate the problem of analgesic nephropathy.