Emkey R D
Am J Med. 1983 Jun 14;74(6A):97-101. doi: 10.1016/0002-9343(83)90536-3.
Historic data has suggested a relationship between aspirin ingestion and the subsequent occurrence of renal papillary necrosis. In most case reports, analgesic mixtures containing aspirin, phenacetin, and caffeine were taken. This resulted in the term "analgesic nephropathy." In clinical studies, phenacetin has been the major common denominator, whereas experimental data in rats implicate aspirin as the major nephrotoxin. Except with massive doses, attempts at producing nephrotoxicity in laboratory animals with phenacetin have failed; however, a high proportion of rats fed aspirin alone have developed renal papillary necrosis. Acute reversible effects of aspirin on renal function in patients with active lupus nephritis have been demonstrated. Data are presented in 46 patients who took aspirin continuously for 10 or more years (mean total dosage 35 kg) in whom there was no evidence of significant renal dysfunction. These data suggest that, while aspirin may cause minor histologic or functional renal abnormalities, it is unlikely that long-term salicylate consumption causes serious renal disease.
历史数据表明阿司匹林摄入与随后发生的肾乳头坏死之间存在关联。在大多数病例报告中，患者服用的是含有阿司匹林、非那西丁和咖啡因的镇痛合剂。由此产生了“镇痛剂肾病”这一术语。在临床研究中，非那西丁一直是主要的共同因素，而大鼠实验数据表明阿司匹林是主要的肾毒素。除了大剂量使用外，用非那西丁在实验动物中诱发肾毒性的尝试均告失败；然而，单独给高比例的大鼠喂食阿司匹林后，它们出现了肾乳头坏死。已证实阿司匹林对活动性狼疮性肾炎患者的肾功能有急性可逆作用。本文展示了46例连续服用阿司匹林10年或更长时间（平均总剂量35千克）的患者的数据，这些患者没有明显肾功能不全的证据。这些数据表明，虽然阿司匹林可能会导致轻微的组织学或功能性肾脏异常，但长期服用水杨酸盐不太可能导致严重的肾脏疾病。
