镇痛剂肾病

镇痛剂肾病(Analgesic nephropathy)是由镇痛药，比如阿司匹林、非那西汀、对乙酰氨基酚等所诱发的肾脏损伤疾病。镇痛剂肾病通常指过度使用这些镇痛药物的组合，特别是包括非那西丁的药物组合。它也可以被用于描述来自于任何单一镇痛药物所引起的肾脏损伤。
由镇痛药所诱发的特异性肾损伤为肾乳头坏死及慢性间质性肾炎。它们出现肾血流量(renal blood flow)的减少、抗氧化剂的快速消耗，以及随后的氧化损伤肾脏的结果等现象。肾损害可能导致进行性的慢性肾功能衰竭、异常尿液分析现象、高血压，及贫血。一小部分具有镇痛剂肾病的病患可能发展为终末期肾病。
镇痛剂肾病一度在欧洲，澳大利亚及美国的部分地区为肾损伤及终末期肾脏病最常见的病症。在大多数地区、其发病率急剧下降，因为在20世纪70年代和80年代使用非那西丁的下降故。
历史.
镇痛药是一类广泛应用于治疗疼痛的药物。它们包括阿司匹林及和其他非甾体抗炎药(NSAIDs)，以及退烧药(Antipyretic)扑热息痛(在美国称为acetaminophen)与非那西丁。在19世纪后期推出，在欧洲，澳大利亚和美国的部分地区非那西丁一度混合镇痛药为复方药(Combination drug)。这些组合的镇痛药含有阿司匹林，或其他药物、如NSAID与非那西丁、扑热息痛或水杨酰胺，以及咖啡因或可待因所组成。
As the use of phenacetin declined, so too did the prevalence of analgesic nephropathy as a cause of end-stage renal disease. Data from Switzerland, for example, demonstrated a decline in the prevalence of analgesic nephropathy among people with end-stage renal disease, from 28% in 1981 to 12% in 1990. An autopsy study performed in Switzerland suggested that the prevalence of analgesic nephropathy in the general population has likewise decreased; the prevalence was 3% in 1980 and 0.2% in 2000.
While these data demonstrate that analgesic nephropathy has been all but eliminated in some regions, in other regions the condition persists. Notably, in Belgium, the prevalence of analgesic nephropathy among people having dialysis was 17.9% in 1984 and 15.6% in 1990. Michielsen and de Schepper suggest that analgesic nephropathy persists among people in Belgian having dialysis not due to non-phenacetin analgesics, but because Belgium accepts a higher proportion of elderly people for dialysis. According to these authors, a greater proportion have analgesic nephropathy because a greater percentage of people in Belgian having dialysis have been exposed to long-term use of phenacetin.-->
病理生理学.
How phenacetin and other analgesics lead to this damage is incompletely understood. It is currently thought that the renal toxicities of NSAIDs and the antipyretics phenacetin and paracetamol may combine to give rise to analgesic nephropathy. A committee of investigators reported in 2000 that there was insufficient evidence to suggest that non-phenacetin analgesics by themselves are associated with analgesic nephropathy.-->
阿司匹林与NSAIDs.
2) produced by the kidney is necessary to support adequate blood flow to the kidney. Like all prostaglandins, PGE2 synthesis depends upon the cyclooxygenases.
Aspirin and other NSAIDs are inhibitors of the cyclooxygenases. In the kidney, this inhibition results in decreased PGE2 concentration causing a reduction in blood flow. Because blood flow to the kidney first reaches the renal cortex (outside) and then the renal medulla (inside), the deeper structures of the kidney are most sensitive to decreased blood flow. Thus the innermost structures of the kidney, called the renal papillae, are especially dependent on prostaglandin synthesis to maintain adequate blood flow. Inhibition of cyclooxygenases therefore rather selectively damages the renal papillae, increasing the risk of renal papillary necrosis.
Most healthy kidneys contain enough physiologic reserve to compensate for this NSAID-induced decrease in blood flow. However, those subjected to additional injury from phenacetin or paracetamol may progress to analgesic nephropathy.-->
非那西汀与扑热息痛.
Paracetamol is the major metabolite of phenacetin and may contribute to kidney injury through a specific mechanism. In cells of the kidney, cyclooxygenases catalyse the conversion of paracetamol into "N"-acetyl-"p"-benzoquinoneimine (NAPQI). NAPQI depletes glutathione via non-enzymatic conjugation to glutathione, a naturally occurring antioxidant. With depletion of glutathione, cells of the kidney become particularly sensitive to oxidative damage.-->
倂发症.
镇痛药肾病的并发症包括肾盂肾炎(pyelonephritis) 及终末期肾病。 Analgesic nephropathy also appears to increase the risk of developing cancers of the urinary system.-->
常指的是被诱导过度使用一些复合药物的所造成的伤害，尤其是那些包括非那西丁的复合药物 use of combinations of these medications, specifically combinations that include phenacetin. For this reason, it is also called analgesic abuse nephropathy. Murray prefers the less judgmental analgesic-associated nephropathy. Both terms are abbreviated to the acronym AAN, by which the condition is also commonly known.-->