Short-term niflumic-acid-induced acute renal failure in children

Several reports emphasize the adverse effects of non-steroidalanti-inflammatory drugs (NSAIDs) on renal function. We haveobserved over the last 10 years seven cases of acute renal failure(ARF) due to immune interstitial nephritis in children. A recommendedoral or rectal dose of niflumic acid was prescribed for ear-nose-throatdisorders, Length of exposure was 1–5 days. Clinical symptoms (oedema, oliguria or anuria) appeared between3 and 6 days. Three patients had previously received the drug.Hypersensitivity signs (fever, skin rash, eosinophilia, and/orincreased IgE) were present in all cases, leukocyturia in fivecases, and haematuria in six cases. Renal biopsy showed interstitiallesions with lymphocyte, eosinophil, and plasma cell infiltrateswithout tubular cell necrosis. Glomeruli were normal on light-microscopy,except in one patient. Electron-microscopy showed extensivepodocyte fusion in two patients, who had clinical and laboratoryevidence of nephrotic syndrome (NS). ARF rapidly disappeared after NSAID withdrawal, except in twopatients whose renal failure was irreversible despite methylprednisolonebolus. ARF is very rare in children treated with niflumic acid.When ARF occurs, different pathophysiological mechanisms areinvolved but the most common is immunological.     

Improvement of renal function in patients with chronic gout after proper control of hyperuricemia and gouty bouts

AIM: To evaluate the effect of nonsteroidal anti-inflammatory drug (NSAID) withdrawal on renal function in patients with chronic gout after proper control of hyperuricemia and gouty symptoms. METHODS: Patients with chronic gout, who regularly used NSAIDs to control gouty symptoms prior to urate-lowering therapy, were prospectively followed up in an observational study. Risk factors for renal function impairment were recorded, and the clearance of creatinine (Ccr) was initially measured while on colchinine therapy to prevent gouty bouts. Therapy with urate-lowering drugs was started in order to keep serum urate levels under 6.0 mg/dl (275 micromol/l), and the Ccr was monitored during the follow-up period. Final assessment of the renal function was made after 1 year free from gouty bouts and without NSAID therapy during this period. RESULTS: 87 patients completed a 1-year period of NSAID withdrawal. Low initial Ccr was related to age, hypertension, hypertriglyceridemia and the presence of previous renal diseases. After proper control of gout and NSAID withdrawal during 1 year, the mean Ccr significantly raised from 94 to 104 ml/min. The improvement was especially significant in patients whose initial Ccr was under 80 ml/min. Their mean Ccr rose from 60 to 78 ml/min, and 12 of 29 patients achieved normal Ccr at the end of the study. No risk factor correlated with improvement of the renal function. CONCLUSIONS: Renal function impairment in patients with chronic gout is mainly related to vascular risk factors, but improvement of the renal function was observed after proper control of hyperuricemia and NSAID withdrawal. Optimal control of hyperuricemia and, therefore, of symptoms of gout should be especially considered in patients with vascular risk factors in order to avoid renal function loss due to NSAID use.     

Emergency treatment of renal colic with intravenous Ketoprofen

The non-steroidal anti-inflammatory drug (NSAID) Ketoprofen (Profenid) is used as intravenous monotherapy incorporated in 0.9% normal saline solution (100 mg Ketoprofen ampoule +200 ml normal saline) in the treatment of renal colic. We present our experience in 65 patients complaining of clinically diagnosed renal colic who were treated by intravenous saline-Ketoprofen. Prospective investigations revaled urinary calculi in 51 patients, oxaluria (crystalluria) in 5, acute colitis in 2, severe myositis in 2, negative investigations in 3 and radiculitis in 2 patients. Positive response was observed in 93.8% of patients as far as pain relief is concerned. Pain relief started within 5–7 minutes after beginning the infusion. Duration of analgesic effect ranged between 4 and 12 hours. Repeating the injection was done for maintenance of analgesia. Side effects included drowsiness in 2 patients, palpitation in 1 patient, epigastric pain in 1, muscular cramp in 1 patient. Ketoprofen, an antiprostaglandin, is a powerful anti-inflammatory and potent analgesic. Intravenous saline-Ketoprofen is a good emergency treatment for acute episodes of renal colic.     

Use of renal risk drugs in hospitalized patients with impaired renal function--an underestimated problem?

BACKGROUND: Inappropriate use of drugs in patients with renal impairment (RI) may be harmful and may have deleterious effects. We aimed to investigate the use of renal risk drugs in such patients in general hospitals and to analyse the relationship to demographic factors, risk factors and occurrence of drug-related problems (DRPs). METHODS: Patients admitted to departments of internal medicine and rheumatology in five general hospitals were included. We recorded demographic data, drugs used, drugs described to be a risk in RI (renal risk drugs), relevant medical history, laboratory data and clinical/pharmacological risk factors. We used levels of glomerular filtration rates, calculated by the Modification of Diet in Renal Disease formula to classify patients into five stages of renal function. DRPs were recorded and assessed in multidisciplinary hospital team discussions. RESULTS: Of the 808 included patients, 293 (36%) had normal renal function (stage 1), 314 (39%) had mild RI (stage 2), 160 (20%) had moderate RI (stage 3), 35 (4%) had severe RI (stage 4) and six (0.7%) had kidney failure (stage 5). Mean number of drugs used per patient in patients with RI (stages 3, 4 and 5) and patients evaluated to have adequate renal function relative to drug therapy (stages 1 and 2): on admission 6.2 vs 4.1; started in hospital 4.3 vs 3.9 and total number of renal risk drugs 6.1 vs 4.5. All but six patients with RI stages 3, 4 and 5 used two or more renal risk drugs. 124 (62%) of the patients with RI stages 3, 4 and 5 had DRPs linked to the renal risk drugs, and 26% of the renal risk drugs were associated with DRPs. The most common drug classes associated with DRPs were antibacterials, antithrombotic agents, angiotensin-converting enzyme (ACE) inhibitors, opioids and non-steroidal anti-inflammatory drugs (NSAIDs). CONCLUSIONS: Among patients admitted to general hospitals, a considerable proportion had renal impairment. In patients with reduced renal function, renal risk drugs were widely used and often in combination. DRPs were frequently associated with the use of renal risk drugs.     

Non-steroidal anti-inflammatory drug-associated nephrotoxicity in Bartter syndrome

We have followed four patients with Bartter syndrome for a mean of 25.4 years (range 21.5–28.8 years) after diagnosis. All patients received non-steroidal anti-inflammatory drugs (NSAID). In all patients, various degrees of renal dysfunction were noted to be temporally associated with NSAID therapy. In two patients, renal dysfunction resolved after discontinuing NSAID therapy, while maintaining other chronic medications such as potassium-sparing diuretics. Renal dysfunction persisted after NSAID withdrawal in two patients. We report these cases as a warning that NSAID should be considered an important cause of either reversible or irreversible renal dysfunction in Bartter syndrome. Received December 2, 1997; received in revised form May 27, 1998; accepted May 29, 1998     

Presentation and outcome of emphysematous renal tract disease in patients with diabetes mellitus

BACKGROUND: Emphysematous renal tract disease (ERTD) is a rare necrotizing infection of the renal parenchyma and urinary tract caused by gas-producing organisms. ERTD deserves special attention because of its life-threatening potential. OBJECTIVES: To study the clinical features, radiological classification and prognostic factors of ERTD; and to compare the modalities of management and the outcome among the various radiological classes of ERTD. PATIENTS AND METHODS: Twenty consecutive patients with diabetes and ERTD, seen over last 3 years in a tertiary care institute of north India, were included in the study. All patients were subjected to computerized tomography (CT) after initial diagnosis by ultrasonography. They were classified into 5 classes as previously described. All patients included in the study were conservatively managed with appropriate antibiotics and/or percutaneous drainage or surgery if required. RESULT: Mean age (+/- SD) of these subjects was 54.4 +/- 20.6 years; duration of diabetes mellitus 8.6 +/- 5.8 years, and duration of symptoms related with ERTD ranged from 3 days to 3 months. Two patients had isolated emphysematous cystitis, 13 patients had emphysematous pyelonephritis (EPN), 3 had both EPN and cystitis, and 1 patient had EPN with cholecystitis, and 1 patient had EPN with pyomyositis. Only 7 (35%) patients had a history of pneumaturia. Escherichia coli was the commonest microorganism. The radiological distribution in 18 (2 had isolated cystitis) patients with EPN was: 2 patients had class 1; 1 had class 2; 2 had class 3A; 11 had class 3B, and 2 had class 4. Of 20 patients 11 (55%) survived. However, those patients who died had severe EPN based on radiological class (6 had class 3B and 1 had class 4). There was no significant difference between the survivor and non-survivor groups with respect to age, gender, duration of diabetes mellitus, duration of symptoms, serum creatinine level, total leukocyte count, hemoglobin, platelet count and culture positivity. CONCLUSION: Computerized tomographic class 3B or 4 is the most reliable predictor of outcome in patients with ERTD.     

移植肾尿路结石的腔内治疗

目的探讨腔内治疗移植。肾尿路结石的效果和策略。方法采用腔内技术治疗13例移植。肾尿路结石，其中。肾结石3例，金属支架结石1例，输尿管结石9例，合并输尿管口狭窄2例。结石最大直径8～48mm，接受肾移植的时间1个月～8年。结果3例。肾结石和1例金属支架结石行经皮微造瘘输尿管镜取石术成功取石。4例输尿管结石行逆行输尿管镜取石治疗；3例行经皮顺行输尿管镜取石成功，其中1例合并移植输尿管口狭窄者同时行内切开取石；1例移植输尿管口狭窄合并下端结石者，改行开放手术；1例输尿管结石直接行体外冲击波碎石术2次后排净结石。术后随访1～8年，人肾存活均良好，12例患者。肾功能恢复正常，无结石复发。结论移植肾尿路结石处理应选择创伤小、效果好的腔内微创治疗，尽可能保护。肾功能。     

改良后腹腔镜肾蒂周淋巴管阻断术治疗乳糜尿7例的临床观察

目的探讨经后腹膜腔利用腹腔镜改良肾蒂周淋巴管阻断术治疗乳糜尿的疗效。 方法2017年3月至2018年7月,茂名市电白区人民医院泌尿外科对7例乳糜尿患者行腹腔镜改良肾蒂周淋巴管阻断术治疗,观察7例患者的手术时间、术中出血量、引流管与尿管的拔管时间、术后连续3 d的乳糜尿试验结果及术后不良反应的发生情况,术后随访2～17个月。 结果7例患者手术均于镜下顺利完成,平均手术时间为75 min,术中平均出血量为7.5 ml;于术后1～4 d拔除腹膜腔引流管,6～7 d拔除尿管;所有患者术后即无乳白色尿液,术后连续3 d复查乳糜尿试验均为阴性;随访期间,均无明显肾周下坠痛及患侧肾下垂情况发生。1例复发者经改善饮食及减少运动量1周后乳糜尿症状消失。 结论经后腹膜腔利用腹腔镜改良肾蒂周淋巴管阻断术治疗乳糜尿保持了肾门部血管、肾盂生理性伸直,手术时程短,术中出血少,患者临床症状消失快,疗效确切。     

微创经皮肾镜取石术治疗幼儿肾结石

目的 探讨微创经皮肾镜取石术(MPCNL)治疗幼儿肾结石的手术技巧. 方法 12例肾结石患儿行MPCNL.男8例,女4例.平均年龄32(18～53)个月.12例均经KUB、IVU、B超和CT检查确诊.结石直径平均1.3(1.0～1.8)cm.单纯肾盂结石7例,合并多发性肾盏结石5例.无合并肾盂输尿管连接处狭窄者.均实施全麻,B超引导下穿刺目标肾盏,成功建立12～16 F皮肾通道并用气压弹道碎石机碎石. 结果 12例平均手术时间74 min.均Ⅰ期完成碎石,Ⅰ期结石清除率67%(8/12).1例残留结石直径>6 mm者行二次MPCNL后结石完全清除,总结石清除率75%(9/12).3例残留结石直径2～4 mm,其中1例术后2周行ESWL.术后平均住院时间14(10～42)d.随访1～7个月,结石清除率100%. 结论 MPCNL具有出血少、结石清除率高、住院时间短等优点,可作为治疗幼儿肾结石安全、有效的方法.     

经输尿管镜下囊肿内切开引流术治疗肾囊肿

目的 探讨经输尿管镜下囊肿内切开引流术治疗肾囊肿的手术疗效和安全性.方法 肾囊肿患者30例.其中肾盂旁囊肿11例,单发囊肿15例,多发囊肿4例.既往肾囊肿手术史者3例.囊肿直径平均6.9(4.0～11.2)cm.影像学检查均可见囊肿对集合系统压迫形成的压迹.使用输尿管镜经尿道顺行至肾盂径路,观察肾囊肿对集合系统的压迫情况,直视下用电刀在囊肿压迫肾盂明显处位置做内切开.使其与集合系统贯通,并置双J管内引流.结果 30例手术均一次成功.囊肿处理时间平均31(15～45)min.手术时间平均61(30～120)min,住院时间平均6.5(4～7)d.无严重并发症发生.术后12 d实验室检查患者蛋白尿消失.平均随访6(3～9)个月,其中囊肿消失24例,明显缩小4例,复发2例.结论 经尿道输尿管镜技术处理肾囊肿具有安全、微创、近期疗效确切等优点.     

Combined subcutaneous recombinant alpha-interferon and interleukin-2 in metastatic renal cell cancer: results of the Multicentre All Ireland Immunotherapy Study Group

OBJECTIVE: To analyse the toxicity and efficacy of combined interferon-alpha and interleukin-2, administered subcutaneously in a general multicentre setting, as treatment for metastatic renal cell carcinoma. METHODS: Thirty-three patients with metastatic renal cell carcinoma were scheduled to receive 2 cyclical doses of subcutaneous interferon-alpha (week 1: 5 MU x 3 days) and interleukin-2 (week 2: 36 MU x 2 days, 9 MU x 3 days; weeks 3-5: 9 MU daily). Karnofsky scores ranged from 80 to 100 (median 90). Metastases occurred in multiple organs (lung 63%, retroperitoneal 39%, liver 24%). Patients were categorised according to the risk of disease progression. Treatment toxicity, therapeutic response and actuarial survival were analysed. RESULTS: All patients received recommended doses of treatment, but 6 received less than 2 cycles. Most were treated as outpatients, although hospitalisation was usual during the 1st week of a cycle. All complained of mild flu-like symptoms. Severe side effects developed in 13 patients (39%), and treatment was discontinued in 3 of these patients. No deaths occurred as a result of treatment. The overall median survival was 10 months. The overall actuarial survival rate at 3 years was 22%. On statistical analysis, actuarial survival rates were not influenced by either response to treatment or risk group category. CONCLUSION: Subcutaneously administered, combined interferon-alpha and interleukin-2 therapy achieves durable survival rates in a minority of patients with renal cell carcinoma. Toxicity is remedial, and not fatal, when subcutaneous therapy is administered by multiple medical disciplines at a variety of centres.     

单边双通道内镜技术治疗腰椎术后邻近节段病变的早期疗效观察

目的:探讨单边双通道内镜技术治疗腰椎术后邻近节段病变的早期临床疗效。方法:2019年6月至2020年6月采用单边双通道内镜技术治疗腰椎术后邻近节段病变患者14例,其中男9例,女5例,年龄52～73岁,2次手术间隔时间19～64个月。腰椎融合术后邻近节段退变患者10例,腰椎非融合固定术后4例;均采用单边双通道内镜辅助下后路单侧椎板开窗椎管减压术或者经单侧入路潜行减压至对侧。观察手术时间、术后住院时间及并发症情况,记录术前、术后3d及术后3、6个月随访时腰痛和腿痛的疼痛视觉模拟评分(visual analogue scale,VAS),Oswestry功能障碍指数(Oswestry disability index,ODI),以及改良的日本矫形外科学会腰椎功能(modified Japanese Orthopedic Association,mJOA)评分。结果:所有手术顺利完成。手术时间32～151 min。术后CT示减压充分,大部分关节突关节得以保留。术后1～3d下床行走,术后住院时间为1～8 d。术后随访时间为6～11个月。14例患者术后3周内均恢复正常生活,术后3d及3、6个月患者...     

超选择性肾动脉分支栓塞术治疗经皮肾镜取石术术后肾出血

目的评价超选择性肾动脉分支栓塞术治疗经皮肾镜取石术（PCNL）术后肾出血的临床价值。方法对PCNL术后并发肾出血的35例患者行超选择性肾动脉分支栓塞术,栓塞材料为0．018in微弹簧圈,部分病例加用少量明胶海绵颗粒。术后随访3-24个月。结果术中造影发现24例单纯肾段以下小动脉损伤,6例合并假性动脉瘤,5例合并动静脉瘘。全部35例患者均成功栓塞肾动脉出血分支,术后1-4天血尿症状消失,术中及术后无严重并发症发生。结论超选择性肾动脉分支栓塞术治疗PCNL术后肾出血安全、快速、有效,可成为其首选治疗方法。     

Minimal change glomerulopathy associated with nonsteroidal antiinflammatory drugs

Of 55 patients with adult onset minimal change glomerulopathy (MCG) studied at our center between 1971 and 1986, five (9%) had an association with the use of nonsteroidal antiinflammatory drugs (NSAIDs). All of the patients were female, and their mean age at the time of diagnosis was 57.4 +/- 11 (SD) (range 47 to 71) years. They had received NSAIDs for an average of 6.9 +/- 6.4 (range, 3 to 18) months before developing proteinuria. The presenting 24-hour urine protein was 11.3 +/- 10.2 (range, 2.1 to 24) g and all patients were hypoalbuminemic (serum albumin less than 3.5 g/dL) with edema. Two patients presented with acute renal insufficiency (serum creatinine greater than or equal to 1.3 mg/dL). Histologically, three patients had MCG associated with interstitial nephritis, and two had no evidence of interstitial disease. All five patients achieved a complete remission after discontinuing the NSAIDs. The remission occurred within 15 days for 80% of patients. A mean follow-up of 6.4 +/- 3.9 (range, 1.3 to 10.5) years was obtained on the patients. At the time of last follow-up, all patients had remained in complete remission, and all patients had normal renal function. Our experience confirms that MCG may present with or without interstitial nephritis. Once the NSAID is discontinued, a complete remission can be expected.     

后腹腔镜肾小肿瘤剜除术12例报告

目的探讨后腹腔镜下肾浅在小肿瘤(3cm)剜除术中不阻断肾动脉的可行性。方法 2005年4月～2009年4月对12例肾单发直径1.2～3.0cm的小肿瘤行后腹腔镜肿瘤剜除术。术中游离肾动脉,预置血管夹,以备肾动脉阻断;常规不阻断肾动脉情况下,距离肿瘤边缘1cm以上褥式外翻缝合1～2针,收紧缝线打结,预先缝线阻断肾肿瘤区血供;距离肿瘤边缘0.5～1cm,剜除肾肿瘤。结果 12例后腹腔镜手术均获成功,无中转开放手术。手术时间90～170min,平均130.3min;1例剜除肾肿瘤时出血较明显,需阻断肾动脉,时间约20min。术中出血量80～400ml,平均150.6ml,无大出血输血病例。3例术后出现肉眼血尿,均在术后3d内消失。住院时间5～7d,平均6.7d。术后病理:肾脏透明细胞癌10例,错构瘤2例,切缘均阴性。12例术后随访3个月～3年,平均15.5月,复查肾功能正常,B超、CT检查无肿瘤复发,无肾脏萎缩。结论后腹腔镜肾小肿瘤剜除术中预先缝线阻断肾局部肿瘤区血供,不阻断肾动脉是安全可行的。     

乙型肝炎病毒感染患者肾移植术后的治疗和预后分析

目的总结乙型肝炎病毒(HBV)感染患者肾移植术后的治疗和预后,以探讨合理的治疗措施。方法HBV感染肾移植患者21例,术前乙型肝炎病毒表面抗原(HBsAg)阳性和(或)HBV-DNA阳性。术后18例应用拉米夫定、3例应用恩替卡韦抗病毒治疗。随访3个月以上。3例肝肾联合移植的患者术后均使用乙型肝炎人免疫球蛋白。术后定期检测患者的肝功能,肝功能出现异常者及时应用护肝药物,必要时停用钙调磷酸酶抑制剂并对症处理,观察肾功能以及移植肾排斥反应、感染、预后等情况。结果术后随访3～75个月,中位时间17个月。21例中死亡5例,余均存活。12例(57%)术后出现不同程度的肝功能异常;经治疗恢复正常6例,好转3例,死亡3例。移植肾功能正常者13例,肾功能异常但未达到移植肾功能衰竭者6例,2例出现移植肾衰竭,重新恢复血液透析或腹膜透析。术后4例共发生5例次移植肾急性排斥反应,经应用甲泼尼龙冲击治疗或抗胸腺细胞球蛋白治疗后逆转。术后出现感染6例,均伴有肝功能明显异常,经治疗后4例治愈,2例死亡。结论HBV感染患者肾移植术后预防性应用抗HBV药物是必要的和有效的;合理使用免疫抑制剂、应用护肝药物可改善患者的预后。     

带袢钢板重建喙锁韧带治疗急性肩锁关节脱位

目的：探讨急性肩锁关节脱位使用带袢钢板重建喙锁韧带的临床疗效,从而寻求较理想的治疗方法。方法：自2008年10月至2010年1月,采用带袢钢板内固定并重建喙锁韧带治疗急性RockwoodⅢ型以上肩锁关节脱位12例。男9例,女3例;年龄31～83岁,平均55岁;左侧8例,右侧4例;车祸伤7例,摔伤4例,运动伤1例。合并肋骨骨折4例,颅脑外伤2例,股骨干骨折1例。临床表现为肩锁关节部位肿胀,喙突和肩锁关节压痛,琴键征阳性,肩关节活动明显受限。手术时间为伤后2～10d,平均6d。治疗后对患者的肩关节活动度、患者的主观感受以及X线表现进行评定。结果：12例均获随访,时间4～19个月,平均11个月。术后15～35d,肩关节基本恢复至正常活动度,内固定未出现移动、脱出、断裂,未再次发生关节脱位。按Karlsson术后疗效评价标准,本组均达到A级。结论：带袢钢板重建喙锁韧带方法简便迅速,术中复位简单、创伤小,术后能早期进行功能锻炼,是急性RockwoodⅢ型以上肩锁关节脱位理想的治疗方法。     

Treatment of childhood hypophosphatasia with nonsteroidal antiinflammatory drugs

Hypophosphatasia (HP) is an inborn error of metabolism that is characterized by reduced bone mineralization. The aim of this investigation was to evaluate treatment of incapacitating lower limb pain in patients with childhood HP using nonsteroidal antiinflammatory drugs (NSAID). All patients (seven boys; age 32 months to 16 years) presented with delayed walking, the typical waddling gait, muscular weakness of the lower limbs, and a limited walking distance. Six patients had severe diffuse lower limb pain following physical activity and were therefore treated with NSAID. The benefit of this treatment was evaluated clinically and by measurement of renally (PGE2) and systemically (PGE-M) derived prostaglandins (PG) in urine before and during therapy. After treatment with NSAID all six patients showed marked clinical improvement with reduced pain, increased muscle strength, and a normalized walking distance. Levels of PGE-M, which had been elevated in four patients prior to therapy, returned to normal. The use of NSAID in childhood HP should be considered as a possible therapeutic approach because the quality of life in these patients is markedly impaired by pain of the limbs. Elevated PG might play a role in the bone metabolism of HP patients.     

Transcutaneous electrical nerve stimulation for pain management in patients with uncomplicated minor rib fractures.

OBJECTIVE: Few non-surgical conditions are more painful than rib fractures. There are a few methods for pain relief in patients with minor rib fractures. METHODS: We used a non-steroidal anti-inflammatory drug (NSAID, Naproxen sodium) and transcutaneous electrical nerve stimulator (TENS) to control pain of the patients with uncomplicated minor rib fractures. One hundred consecutive patients admitted to Kartal Education and Research Hospital Emergency Service, were randomized into four groups. The patients were assigned to one of the following pain treatments: NSAID, TENS, NSAID plus inactive TENS or placebo. The patients used NSAIDs and placebo four times a day and TENS twice a day for 3 days. All patients were asked to assess their pain level with a scoring system on days 0, 1 and 3. RESULTS: The most effective treatment was TENS on days 1 and 3 (P<0.05). Although NSAID and NSAID plus inactive TENS controlled pain better than placebo on day 1 (P<0.05), this superiority did not continue to day 3 (P>0.05). There was no difference between NSAID and NSAID plus inactive TENS in controlling pain on either days 1 or 3. CONCLUSION: We conclude that TENS was more effective than NSAID or placebo in patients with uncomplicated minor rib fractures, because of its prominent and admirable efficacy in reduction of pain.     

Analgesic and non-steroidal anti-inflammatory drug-associated acute renal failure: a prospective collaborative study

During a one-year period analgesic and non-steroidal anti-inflammatory drug-(NSAID) associated acute renal failure (ARF) was recorded in 147 of 398 patients registered in 58 nephrology units. This figure represented 36.9% of drug-associated ARF, and 6.8% of total patients with ARF hospitalized during the same period. Drugs involved were primarily glafenin (79), NSAID (62), paracetamol (5) and phenacetin (1 case). Hypersensitivity reactions were documented in 32 patients. Acute tubular necrosis was found in 20, and interstitial nephritis (AIN) in 9 of 34 biopsied patients. All patients in the glafenin group and 71.4% in the NSAID group recovered fully or regained previous renal function (p less than 0.01). Permanent renal damage (9.5% of total cases) was more frequent in patients with AIN than in those with other types of ARF (p less than 0.001). Preventive measures should be especially directed to older patients receiving NSAID, by avoiding the combined use of drugs potentiating their action and by correcting any predisposing factor to ARF.