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镇痛药相关的慢性肾脏疾病

Author
Marc E De Broe, MD, PhD
Section Editor
Gary C Curhan, MD, ScD
Deputy Editor
Alice M Sheridan, MD
Translators
王玉, 副主任医师，副教授

引言

人们在20世纪50年代早期就已发现非麻醉性镇痛药与进展性慢性肾脏病(chronic kidney disease, CKD)有关[1,2]。

和最初的描述一样，镇痛药性肾病是一种已获得明确描述的CKD，特征为肾乳头坏死和慢性间质性肾炎，由长期和过量使用含有多种镇痛药的专利复方制剂(proprietary mixtures)引起，相关药物包括阿司匹林、安替比林、非那西丁、对乙酰氨基酚、水杨胺、咖啡因和可待因[3-7]。镇痛药性肾病有明确的组织学和影像学特征，曾是CKD的一个重要病因，尤其在澳大利亚、欧洲部分国家及美国[3-5]。

然而，在非那西丁退出市场，以及立法规定复方镇痛药只能以处方药形式获取后，镇痛药性肾病的发病率显著下降。由于这些措施几乎同时出现，所以难以确定是哪项措施降低了发病率。

含和不含非那西丁的复方镇痛药相关的镇痛药性肾病的发病率下降后，许多报告显示单一镇痛药也可以导致CKD，不过其组织学和影像学特征不像前者那么明确。因此单一镇痛药所致CKD的文献记录较少。

本专题将总结含和不含非那西丁复方镇痛药相关的镇痛药性肾病及与单一镇痛药相关CKD的流行病学、危险因素及发病机制。镇痛药性肾病的临床表现和诊断，以及非甾体类抗炎药(nonsteroidal anti-inflammatory drug, NSAID)相关急性肾脏损伤(acute kidney injury, AKI)，参见其他专题。 (参见“镇痛药性肾病的临床表现和诊断”和“非甾体类抗炎药：急性肾损伤(急性肾衰竭)”)

            

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-05.
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References
Top
  1. SPUHLER O, ZOLLINGER HU. [Chronic interstitial nephritis]. Z Klin Med 1953; 151:1.
  2. Dubach UC, Rosner B, Stürmer T. An epidemiologic study of abuse of analgesic drugs. Effects of phenacetin and salicylate on mortality and cardiovascular morbidity (1968 to 1987). N Engl J Med 1991; 324:155.
  3. Buckalew VM Jr, Schey HM. Renal disease from habitual antipyretic analgesic consumption: an assessment of the epidemiologic evidence. Medicine (Baltimore) 1986; 65:291.
  4. De Broe ME, Elseviers MM. Over-the-counter analgesic use. J Am Soc Nephrol 2009; 20:2098.
  5. Pintér I, Mátyus J, Czégány Z, et al. Analgesic nephropathy in Hungary: the HANS study. Nephrol Dial Transplant 2004; 19:840.
  6. Noels LM, Elseviers MM, de Broe ME. Impact of legislative measures on the sales of analgesics and the subsequent prevalence of analgesic nephropathy: a comparative study in France, Sweden and Belgium. Nephrol Dial Transplant 1995; 10:167.
  7. Nanra RS. Analgesic nephropathy in the 1990s--an Australian perspective. Kidney Int Suppl 1993; 42:S86.
  8. Nanra RS, Stuart-Taylor J, de Leon AH, White KH. Analgesic nephropathy: etiology, clinical syndrome, and clinicopathologic correlations in Australia. Kidney Int 1978; 13:79.
  9. Mihatsch MJ, Hofer HO, Gudat F, et al. Capillary sclerosis of the urinary tract and analgesic nephropathy. Clin Nephrol 1983; 20:285.
  10. Bach PH, Hardy TL. Relevance of animal models to analgesic-associated renal papillary necrosis in humans. Kidney Int 1985; 28:605.
  11. Duggin GG. Combination analgesic-induced kidney disease: the Australian experience. Am J Kidney Dis 1996; 28:S39.
  12. Dubach UC, Rosner B, Pfister E. Epidemiologic study of abuse of analgesics containing phenacetin. Renal morbidity and mortality (1968-1979). N Engl J Med 1983; 308:357.
  13. Sandler DP, Smith JC, Weinberg CR, et al. Analgesic use and chronic renal disease. N Engl J Med 1989; 320:1238.
  14. Elseviers MM, De Broe ME. A long-term prospective controlled study of analgesic abuse in Belgium. Kidney Int 1995; 48:1912.
  15. Dubach UC, Rosner B, Stürmer T. Epidemiologic study of analgesic abuse: mortality study in 7275 working women (1968-1987). Kidney Int 1991; 40:728.
  16. Perneger TV, Whelton PK, Klag MJ. Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal antiinflammatory drugs. N Engl J Med 1994; 331:1675.
  17. Brunner FP, Selwood NH. End-stage renal failure due to analgesic nephropathy, its changing pattern and cardiovascular mortality. EDTA-ERA Registry Committee. Nephrol Dial Transplant 1994; 9:1371.
  18. Mihatsch MJ, Khanlari B, Brunner FP. Obituary to analgesic nephropathy--an autopsy study. Nephrol Dial Transplant 2006; 21:3139.
  19. Vadivel N, Trikudanathan S, Singh AK. Analgesic nephropathy. Kidney Int 2007; 72:517.
  20. Feinstein AR, Heinemann LA, Curhan GC, et al. Relationship between nonphenacetin combined analgesics and nephropathy: a review. Ad Hoc Committee of the International Study Group on Analgesics and Nephropathy. Kidney Int 2000; 58:2259.
  21. De Broe ME, Elseviers MM. Analgesic nephropathy. N Engl J Med 1998; 338:446.
  22. Michielsen P, de Schepper P. Trends of analgesic nephropathy in two high-endemic regions with different legislation. J Am Soc Nephrol 2001; 12:550.
  23. McLaughlin JK, Lipworth L, Chow WH, Blot WJ. Analgesic use and chronic renal failure: a critical review of the epidemiologic literature. Kidney Int 1998; 54:679.
  24. Delzell E, Shapiro S. A review of epidemiologic studies of nonnarcotic analgesics and chronic renal disease. Medicine (Baltimore) 1998; 77:102.
  25. Gault MH, Barrett BJ. Analgesic nephropathy. Am J Kidney Dis 1998; 32:351.
  26. Bennett WM, Porter GA. Analgesic nephropathy and the use of nonsteroidal anti-inflammatory drugs in renal patients: new insight. J Nephrol 1998; 11:70.
  27. van der Woude FJ, Heinemann LA, Graf H, et al. Analgesics use and ESRD in younger age: a case-control study. BMC Nephrol 2007; 8:15.
  28. Fored CM, Ejerblad E, Lindblad P, et al. Acetaminophen, aspirin, and chronic renal failure. N Engl J Med 2001; 345:1801.
  29. Curhan GC, Knight EL, Rosner B, et al. Lifetime nonnarcotic analgesic use and decline in renal function in women. Arch Intern Med 2004; 164:1519.
  30. Rexrode KM, Buring JE, Glynn RJ, et al. Analgesic use and renal function in men. JAMA 2001; 286:315.
  31. Kurth T, Glynn RJ, Walker AM, et al. Analgesic use and change in kidney function in apparently healthy men. Am J Kidney Dis 2003; 42:234.
  32. Prescott LF. Analgesic nephropathy: a reassessment of the role of phenacetin and other analgesics. Drugs 1982; 23:75.
  33. Barrett BJ. Acetaminophen and adverse chronic renal outcomes: an appraisal of the epidemiologic evidence. Am J Kidney Dis 1996; 28:S14.
  34. Segasothy M, Suleiman AB, Puvaneswary M, Rohana A. Paracetamol: a cause for analgesic nephropathy and end-stage renal disease. Nephron 1988; 50:50.
  35. Agodoa LY, Francis ME, Eggers PW. Association of analgesic use with prevalence of albuminuria and reduced GFR in US adults. Am J Kidney Dis 2008; 51:573.
  36. Emkey RD, Mills JA. Aspirin and analgesic nephropathy. JAMA 1982; 247:55.
  37. D'Agati V. Does aspirin cause acute or chronic renal failure in experimental animals and in humans? Am J Kidney Dis 1996; 28:S24.
  38. Ibáñez L, Morlans M, Vidal X, et al. Case-control study of regular analgesic and nonsteroidal anti-inflammatory use and end-stage renal disease. Kidney Int 2005; 67:2393.
  39. Bennett WM, Henrich WL, Stoff JS. The renal effects of nonsteroidal anti-inflammatory drugs: summary and recommendations. Am J Kidney Dis 1996; 28:S56.
  40. Sandler DP, Burr FR, Weinberg CR. Nonsteroidal anti-inflammatory drugs and the risk for chronic renal disease. Ann Intern Med 1991; 115:165.
  41. Wagner EH. Nonsteroidal anti-inflammatory drugs and renal disease--still unsettled. Ann Intern Med 1991; 115:227.
  42. Segasothy M, Samad SA, Zulfigar A, Bennett WM. Chronic renal disease and papillary necrosis associated with the long-term use of nonsteroidal anti-inflammatory drugs as the sole or predominant analgesic. Am J Kidney Dis 1994; 24:17.
  43. Gooch K, Culleton BF, Manns BJ, et al. NSAID use and progression of chronic kidney disease. Am J Med 2007; 120:280.e1.
  44. Thakar CV, Christianson A, Himmelfarb J, Leonard AC. Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus. Clin J Am Soc Nephrol 2011; 6:2567.
  45. Wei L, MacDonald TM, Jennings C, et al. Estimated GFR reporting is associated with decreased nonsteroidal anti-inflammatory drug prescribing and increased renal function. Kidney Int 2013; 84:174.