PATHOPHYSIOLOGIC MECHANISMS IN ANALGESIC-INDUCED PAPILLARY NECROSIS

The nonnarcotic analgesics have been implicated as a significant cause of chronic renal failure worldwide, Epidemiologic studies of habitual abuse and necropsy studies show a strong relationship between the two , Animal studies designed to elucidate underlying mechanisms have been hampered because the lesion occurs infrequently and only after very h igh doses are given for prolonged periods; however, the Fischer 344 an d Wistar rats appear to be more sensitive, and substantial new informa tion should be forthcoming, In this review, some of the evidence for t he possible mechanisms of papillary necrosis are presented: prostaglan din inhibition, reduction or redistribution of renal blood flow, direc t cellular injury, free radical formation, and immunologic injury, At present, most data support prostaglandin inhibition and reduction or r edistribution of renal blood flow, but direct cellular injury also app ears to be very important. (C) 1996 by the National Kidney Foundation, Inc.