Q: I have read that pain killers can cause damage to the kidney. What is the guideline for taking pain killers in an acute renal condition? According to our family doctor who is incidentally our relative says that several types of pain killers can damage the kidneys. Tylenol, aspirin, and NSAIDs (non-steroidal anti-inflammatory drugs, such as ibuprofen and naproxen) are examples. There is evidence that very large doses of these medications, on the order of thousands of tablets taken over several years, may cause kidney damage in some people. However, not everyone who takes such large amounts of these medications will develop kidney damage. In others, kidney damage can be severe and permanent so that the person requires dialysis (artificial kidney) treatments. What is the exact position? My brother-in-law, a patient of CRF, has been admitted to alleviate the symptoms of gout. He used to take Voveran frequently, which started impairing his kidney functions. Can you throw light on the use of pain killers and its correlation with renal problems?

A:Pain is of various types and hence appropriate medicine is to be taken. For simple pain (such as headache, muscle pain etc), one should take only simple pain-killers such as paracetamol (Crocin, Calpol, etc). Only when the pain is accompanied by severe inflammation, does one need to take a member of the NSAID group of drugs such as diclofenac, ibuprofen, indomethacin, etc. that too when prescribed by a qualified doctor. Unfortunately there are two problems in India: availability of illegal, harmful combination of two or more pain-killers (resulting in addition of side effects) and self-medication by patients involving potent NSAIDs; at least one of them (nimesulide) is globally banned or discarded due to its unacceptable side effects. The major effect of NSAIDs is on stomach (immediate) and heart (in due course). As a class NSAIDs are also associated with renal effects but only when large quantities are consumed over prolonged periods.