Elseviers M M, De Broe M E
Department of Nephrology-Hypertension, University of Antwerp, Belgium.
Drugs Aging. 1998 May;12(5):391-400. doi: 10.2165/00002512-199812050-00005.
Nephropathy caused by the use of 'classical' analgesics [paracetamol (acetaminophen), salicylates and pyrazolone derivatives] and renal impairment associated with nonsteroidal anti-inflammatory drugs (NSAIDs) are important health problems in the elderly. Classical analgesic nephropathy is a chronic renal disease characterised by renal papillary necrosis and chronic interstitial nephritis. The nephropathy is caused by the excessive consumption of analgesic mixtures containing at least 2 antipyretic analgesics combined with caffeine and/or codeine. The use of NSAIDs is associated with a wide range of tubular, interstitial, glomerular and vascular renal lesions. Despite the well-characterised acute biological effects of NSAIDs on the kidney, there is only limited evidence that they are associated with an increased risk of chronic renal failure. Classical analgesic toxicity can be effectively prevented by limiting the availability of over-the-counter analgesic mixtures containing 2 analgesic compounds in combination with potentially addictive substances (e.g. caffeine and/or codeine). In the elderly in particular, the prolonged, regular use of NSAIDs should be discouraged. Patients starting NSAID therapy should be monitored regularly and drug interactions should be avoided.
使用“传统”镇痛药（对乙酰氨基酚、水杨酸盐和吡唑酮衍生物）引起的肾病以及与非甾体抗炎药（NSAIDs）相关的肾功能损害是老年人重要的健康问题。传统镇痛药性肾病是一种以肾乳头坏死和慢性间质性肾炎为特征的慢性肾脏疾病。该肾病是由过量服用含有至少两种解热镇痛药并与咖啡因和/或可待因混合的镇痛合剂所致。使用NSAIDs与多种肾小管、间质、肾小球和血管性肾脏病变有关。尽管NSAIDs对肾脏的急性生物学效应已得到充分描述，但仅有有限的证据表明它们与慢性肾衰竭风险增加有关。通过限制含有两种镇痛化合物并与潜在成瘾物质（如咖啡因和/或可待因）混合的非处方镇痛合剂的可得性，可有效预防传统镇痛药性毒性。尤其对于老年人，应不鼓励长期、规律使用NSAIDs。开始NSAID治疗的患者应定期监测，并应避免药物相互作用。
