Analgesic Nephropathy. Clinical Course after Withdrawal of Phenacetin

Abstract

Postgraduate Education-Pickering prime objective, but in our view the time for reducing the duration of the curriculum up to full registration does not appear to have come." In-my own university, despite the unusual distinction of its teachers, progressive assessment of students has not yet been accepted as either possible or desirable. The risk that the Council fosees is displayed as eloquently as it could be "that in these matters of assessing and testing students a teacher will see and approve the better, but follow the worse course." The time exacted from the student in written examination time in anatomy, physiology, and biochemistry in the reformed medical course is to rise from six to eleven hours. Despite the best intentions change is not always synonymous with improvement.Much also remains for the universities to do in supervising preregistration appointments, and particularly in providing an advisory service in postgraduate appointments to its own graduates; and we have seen neither teaching nor examination practices match the changes in ideas that have occurred in educational leadership. " New wine " poured into " old bottles " is not a remedy for instant success. Nevertheless the attitude of mind has changed, and in circles which are less conservative than universities that change of attitude has found practical expression, as in this institute whose opening we celebrate today.Lesson from Medicine May I return to my original theme ? As we have seen, the key to the liberation of medicine was the recognition that education does not, and should not, and indeed cannot, end with a university degree. That degree should not be the end, it should merely be the end of the beginning. This is not a new idea. Winston Churchill remarked to the undergraduates at Bristol University in 1929: " The most important thing about education is appetite. Education does not begin with the university and it certainly ought not to end there." Education in Britain can be shaped to help our young to lead enjoyable, satisfying, and useful lives, but it will be so shaped only when this elementary truth has sunk into our masters and the British public. If we established graduate schools for the advanced study of the arts and the sciences, and if we established graduate schools to train technocrats and all the managerial classes, through business managers, insurance agents, to local government officials, then it would be possible to liberate the undergraduate curriculum and to stop once and for all that hideous Solomon's choice that we exact from our young. They will no longer be asked to abandon the arts or the sciences on the brink of puberty and thus deny themselves for the rest of their lives participation in half of the intellectual ventures in mankind.If we furnish the stimulus, the opportunity, and the facilities for self-education throughout life, schoolmaster, business man, engineer, and those who conduct our public affairs can remain au courant with changing knowledge, thought, and practice. The leisured can use their leis...

Analgesic Nephropathy: Clinical Syndrome and Prognosis

“…The predominance of middle-aged women with psychiatric disorders has been previously noted (Dawborn et al, 1966;McMillan et al, 1968), as has the high incidence of peptic ulceration and anaemia (Prescott, 1966;Dawborn et al, 1966). Our results confirm the diagnostic value of sterile pyuria (Bell et al, 1969) and renal colic and haematuria (Dawbom et al, 1966), as these occurred in more than one-quarter of our patients. Urinary tract infection was not uncommon, particularly in the terminal stages, but appears less common than in Sweden, where Bengtsson and Hood (1965) found 60% of cases of chronic non-obstructive pyelonephritis to be assoc'iated with analgesic abuse.…”

“…Improvement occurred both in those with considerable remaining renal function and in those with a creatinine clearance of less than 10 ml/minute. Other workers have reported similar improvement in smaller numbers of patients (Harvald, 1963;Bell et al, 1969), and, like Bell et al (1969), we have found pyelonephritis to be the maior hazard.…”

Increased Prevalence of Coronary Heart Disease in Analgesic Nephropathy: Relation to Hypertension, Hypertriglyceridemia and Combined Hyperlipidemia

“…Analgesic nephropathy is a common cause of chronic renal failure in Aus tralia [12,20,21,26] and though it may be associated with severe renal failure it remains, nevertheless, a disease which can be adequately controlled with good medical management and the cessation of analgesics [22,27,28]. Despite potential recovery of some parameters of renal function, especially urinary concentrating ability and ammonia excretion [22], patients with analgesic nephropathy constitute a significant portion of patients undergoing chronic hemodialysis and renal transplantation [12].…”

Analgesic Nephropathy: Removal of Phenacetin from Proprietary Analgesics

“…Patients with Established Analgesic Nephropathy.-As it has been shown that recovery ofrenal function depends on abstinence from analgesics (Bell et al, 1969;Kincaid-Smith, 1970;Nitzsche and Bock, 1970;Murray et al, 1971a), patients were repeatedly advised to stop taking them. In spite of this 31 patients continued their analgesic abuse unabated.…”