The Occurrence and Clinical Features of Analgesic Abuse in Western Scotland

Screening of patients referred to a Renal Clinic in Western Scotland over a period of 6 months revealed that 18 patients out of a total of 127 had a history of analgesic abuse, defined as a total consumption of phenacetin or salicylate in excess of 1 Kg. A further 8 patients with analgesic abuse were admitted to the Renal Unit with uraemia and electrolyte disturbance. Renal function was assessed in the whole group of 26 patients; creatinine clearance was significantly reduced in almost all, and a relationship was demonstrated between creatinine clearance and the total dose of phenacetin ingested. Renal concentrating power was markedly reduced in most, and in general the degree of impairment was worst in those with low creatinine clearances. The findings on intravenous pyelography are described; it was not possible in any case to distinguish the appearances from those found in chronic pyelonephritis. Isotope renogram was abnormal in 17 out of 21 patients, and in 4 patients there was delay in the excretory phase of the renogram despite an apparently normal intravenous pyelogram. Half of the patients studied had bacteriological evidence of urinary tract infection, and 11 out of 26 had varying degrees of anaemia; types of anaemia seen included haemolytic anaemia, sideroblastic anaemia and hypochromic anaemia. In general, the clinical picture in patients with a history of analgesic abuse was fairly non-specific, although there are several associations of signs and symptoms which now suggest that this diagnosis should be considered.