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Tell Your Kidneys to Take a Powder

Stephen R. Mitchell, MD
Arch Intern Med. 1991;151(3):617. doi:10.1001/archinte.1991.00400030143032.
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To the Editor.— —  Stillman and Schlesinger1 recently elegantly reviewed the renal hazards of the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and the physiologic considerations for drug choices in patients at high risk for nephrotoxicity. Unfortunately, the most common indications for NSAIDs are inflammatory or noninflammatory pain syndromes that engender their chronic use. The NSAID will commonly be used not only in combination with medications such as diuretics, but also with caffeine and other analgesics.In 1984, a National Institutes of Health consensus conference on chronic analgesic nephropathy (causing 2% to 10% of end-stage renal disease) described the use of drug combinations in the over-the-counter marketplace as a significant community risk, and the industry responded by removing phenacetin from headache powders.2 We have also learned from a case-control telephone survey of 554 adults with newly acquired renal disease that not only is the renal risk because of the


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