Analgesic nephropathy is part of a wider clinical syndrome associated with the abuse of APC compounds, that is, a minimum total intake of 2 kg of aspirin or phenacetin. Ischaemic heart disease and premature aging are newly recognized aspects of the analgesic syndrome. The diagnosis of analgesic nephropathy can be made precisely by the radiological demonstration of renal papillary necrosis. The most important aspect of management of established analgesic nephropathy and renal insufficency is total avoidance of all non-steroid antiinflammatory agents and this is commonly associated with stabilization or improvement in renal function. In the APC mixture, aspirin appears to be the major nephrotoxic agent while phenacetin and paracetamol play a secondary and synergistic role in the nephrotoxicity.