>3. The analgesic nephropathy[interstitial nephritis] was more of an
>issue I thought with chronic dosing with "tylenol with codeine" in the
>NEJM article and not regular acetaminophen.
You're right. The article didn't point the finger at acetaminophen alone -
though I felt it left the issue hanging - but rather at combinations.
However, we never know what else our patients might be consuming that we
have not recommended, nor what other environmental agents might be out there
In Central Australia, among the Aboriginal people, there is a recently
recognized epidemic of renal failure which was not apparent 20 years ago.
One of the things that has been introduced during that time has been the
liberal handing out of 'pain tablets' -acetaminophen. I have shown the NEJM
article to our renal physicians as they are still scratching their heads as
to the cause of the current exponential increase in the number of people
needing to go on dialysis.
The renal biopsies taken from these people are not consistent with classical
analgesic nephropathy - but they are not consistent with any other pattern
As a point of interest Torodol didn't get a good start in Australia. There
is a story that is was given IM to the son of an anesthesiologist in one of
our larger cities and it promptly sent him into acute renal failure. Even
20 years ago one of my teachers used to refer to indomethacin as a *chemical
Dr Greg Winterflood BA MBBS DA DRCOG
Director Emergency Department
Alice Springs Hospital
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