Analgesic abuse in the elderly. Renal sequelae and management

Area of Science:

• Nephrology
• Geriatric Medicine
• Pharmacology

Background:

• Analgesic nephropathy and renal impairment from NSAIDs are significant health concerns in the elderly population.
• Classical analgesic nephropathy involves renal papillary necrosis and chronic interstitial nephritis, often due to excessive use of analgesic mixtures.
• NSAID use is linked to diverse renal lesions, though chronic renal failure risk is less established.

Purpose of the Study:

• To review the impact of classical analgesics and NSAIDs on kidney health in the elderly.
• To highlight the mechanisms and risk factors associated with analgesic and NSAID nephropathy.
• To provide recommendations for preventing renal complications in elderly patients using these medications.

Main Methods:

• Review of literature on analgesic nephropathy and NSAID-induced renal injury.
• Analysis of pathological characteristics of classical analgesic nephropathy.
• Examination of the spectrum of renal lesions associated with NSAID use.

Main Results:

• Classical analgesic nephropathy results from excessive consumption of analgesic mixtures (e.g., paracetamol, salicylates, pyrazolone derivatives) with caffeine/codeine.
• NSAIDs can cause acute tubular, interstitial, glomerular, and vascular renal lesions.
• Limited evidence suggests NSAIDs may increase chronic renal failure risk in the elderly.

Conclusions:

• Preventing classical analgesic nephropathy involves restricting access to over-the-counter analgesic combinations.
• Prolonged, regular NSAID use should be discouraged in the elderly.
• Monitoring patients on NSAIDs and avoiding drug interactions are crucial for renal protection.