Anti-inflammatory drugs and renal papillary necrosis

The literature on renal papillary necrosis (RPN) associated with the administration of non-steroidal antiinflammatory drugs (NSAID) to rats and man, is reviewed. RPN is almost universally reported after long term administration of NSAID to rats, reports being cited for an indomethacin analog, phenylbutazone, fenamic acids, fenoprofen and sudoxicam. Aspirin will also induce RPN in rats, and is probably the cause of the ‘analgesic nephropathy’ linked to abuse of aspirin/phenacetin combinations in man. RPN is reported at autopsy in human arthritics, but whether this is a facet of the disease, or of long term salicylate ingestion, is not clear. NSAID are rarely implicated in RPN in humans.