A lot of IgAN patients complain about
having headaches, often very severe and persistent ones.
How to treat them is a problem: our literature advises
against using aspirin, acetaminophen (Tylenol, etc.) or
There is an entire class of kidney
disease called "analgesic nephropathy" resulting
from the use (or overuse) of analgesics like aspirin,
acetaminophen, and ibuprofen. Most cases of analgesic
nephropathy, at least in the United States, come from
combination products containing phenacetin. The Handbook
of Non-Prescription Drugs notes: "The potential
for abuse of this compound and the incidence of toxicity .
. . have prompted the FDA advisory review panel to
recommend removing phenacetin from nonprescription drug
products." Questions about the other three drugs
destroys the ability of blood platelets to synthesize
thromboxane A2, which causes platelets to clump
together. Interfering with its production inhibits
platelet aggregation, thus making aspirin useful in
preventing strokes and heart attacks. But aspirin is
implicated in the development of Reye's Syndrome, a
potentially fatal neurologic disorder that can attack
young adults and children. It can also damage the lining
of the stomach. Those who take large daily doses of
aspirin, such as people with arthritis, often use highly
buffered aspirin, which reduces erosion of the
gastrointestinal tract but contains large amounts of
sodium, which should be avoided by those on low-sodium
diets. According to the Handbook of Non-Prescription
Drugs, aspirin alone is not believed to cause
analgesic nephropathy, but "it may worsen or
perpetuate the progression of papillary necrosis and renal
Like aspirin, acetaminophen is
both an analgesic and antipyretic (used in bringing down
fevers). As it has gained favor in the U. S., however,
there has also be growing concern that its ready
availability, combined with the public's lack of
appreciation of the dangers of acetaminophen toxicity, may
"produce a new health hazard." Acetaminophen can
damage the kidneys (and has been linked to analgesic
nephropathy), but it is toxic primarily to the liver.
Chronic poisoning is aggravated by alcohol consumption;
acute poisoning can produce fatal necrosis of the liver.
Because of its easy availability, it is often the drug of
choice for young people attempting suicide. (They will
survive the night, but unless antidoted will die within
days from liver failure.) Since problems with the liver's
clearance of immune complexes from the body may be
implicated in the development of IgAN, drugs that are
hepatotoxic (toxic to the liver) may be every bit as
dangerous to an IgAN patient as drugs that are nephrotoxic
(toxic to the kidneys).
stronger than aspirin and its effects last longer. Like
aspirin, it reduces platelet aggregation and increases the
time it takes blood to clot (an effect greatly enhanced by
drinking alcohol). Ibuprofen also cuts down on renal
prostaglandin synthesis; it can cause sodium and water
retention and decrease kidney function. Glomerular
filtration rate declined in patients with mild kidney
impairment who took 1,200 mg/day of ibuprofen for one
This may seem like a lot of ibuprofen,
but it is less than the recommended daily dosage for
menstrual cramps. Those with kidney disease, high blood
pressure, diabetes, lupus, asthma, heart disease, or a
history of aspirin sensitivity should avoid ibuprofen. One
review of the medical literature noted: "It is
unquestionable that ibuprofen can cause renal damage,
including functional acute renal failure, water and
electrolyte disorders, and interstitial nephritis."
The same study further noted that those most at risk for
kidney damage were people who had a low volume of blood in
their veins, such as those who'd lost blood in an
accident, or who had weak hearts.
Analgesics interfere with prostaglandin
production. In healthy people, prostaglandins have little
effect on kidney function; but in people whose kidneys are
impaired, particularly when the flow of blood to the organ
is reduced (by cirrhosis of the liver, heart failure, or
low blood volume), they are important to maintaining renal
function. The effects of different prostaglandins are
conflicting: some are vasodilators and inhibit platelet
aggregation, while others are vasoconstrictors and promote
platelet aggregation. From the kidneys' point of view,
however, analgesics likes aspirin, acetaminophen and
ibuprofen seem to interfere with the production of
"good" prostaglandins as well as of the
"bad" ones that contribute to kidney damage.
We don't know how much harm analgesics
may do to the kidneys of IgAN patients because there have
been no studies on this subject. It seems prudent,
however, to act on the assumption that damage is likely to
develop earlier and be more widespread in kidneys already
injured by glomerulonephritis than in healthy kidneys.
The Network has guidelines for treating
headache pain with hydrotherapy, breathing and relaxation
techniques, and homeopathy, none of which requires using
anything toxic to the kidneys. For more information see
1. American Pharmaceutical Association
& National Professional Society of Pharmacists, Handbook
of Non-Prescription Drugs, 8th ed., p. 204.
3. Ibid., p. 203.
4. JFE Mann, et al., "Ibuprofen as
An Over-the-Counter Drug: Is There A Risk for Renal
Injury?" Clinical Nephrology, v. 39, no. 1
(1993), p. 4.
5. Handbook of Non-Prescription Drugs,
6. Mann, p. 1.
7. Ibid., p. 5.
[Reprinted from Network News, No.
5 (October 1995)]