Pain Killers and Kidney
Analgesics (pain killers) are one of the most important causes of permanent kidney damage. These drugs are grouped as NSAIDs or Non-steroidal anti-inflammatory drugs.
In European countries these form one of the commonest cause of CKD in countries like Belgium, Sweden, Australia and US. With greater awareness of this problem, the incidence is decreasing in the western world while more and more cases are being diagnosed in India.
The vultures, hawks, and raptors, crows and similar birds are on the verge of extinction. A theory postulating the cause of this decline in their numbers is consumption of carcass of dead animals fed analgesics for fattening and milk productions. The analgesics remaining in the dead tissue causes kidney failure in these birds resulting in their premature death.
The commonest drug implicated is phenacetin in combination with aspirin and codeine. Combination drugs are more likely to cause kidney damage. Ingestion of 1000 to 5000 tab is sufficient to cause permanent renal damage.
Most countries have banned phenacetin while in many analgesics are not sold without a prescription.
The disease is more common in a woman suffering from a headache, arthritis or a backache. Psychological dependence and abuse of analgesics is a common problem. This causes further abuse of the drugs and often denial of the same. Underestimation of analgesic abuse is common.
These drugs may also cause edema of feet, high blood pressure, atherosclerosis of blood vessels and damage to the stomach and intestines. These have also caused urinary bladder tumours of malignant variety.
The kidney damage starts in the tip of filtering system called papilla. These are may become thick, calcified and may break off (papillary necrosis). This is a result of less blood supply to this area of the kidney.
Additionally, NSAIDs may also cause AKI (acute kidney injury) by a mechanism akin to allergy.
These diseases can be prevented by limiting analgesic usage to only situations where medically needed while keeping a watch on dosage and regular monitoring of kidney function.