Renal Papillary Necrosis and Aspirin

Abstract

Unexplained renal papillary necrosis with macrocytic anaemia was present in a 58-year-old man who had taken approximately 7 tablets of aspirin daily for 2 to 3 years. There was no history of regular consumption of preparations containing phenacetin. The blood urea level was never elevated but the creatinine clearance was moderately reduced; there was impairment of urinary concentration and the excretion of titratable acid and NH₄⁺ was abnormally low following administration of ammonium chloride. There is considerable clinical and experimental evidence of the nephrotoxicity of salicylates and it is possible that the nephrotoxicity attributed to phenacetin could in many cases be due to the salicylate taken with it.