Nurofen Plus toxicity—what should nephrologists be alert to? Rare complications of an increasingly misused medication

We report the staggered clinical course of a young Caucasian female who suffered rare deleterious effects of Nurofen Plus misuse with a near fatal outcome. Several life-threatening events intervened before the underlying problem of serious dependency was identified. Effects on renal tubular acidification and bone marrow function as well as the commoner complications of acute kidney injury and peptic ulceration are described. In addition, this is the first case report in which the syndrome of reversible posterior leucoencephalopathy is linked to analgesic misuse, occurring after recovery of renal function. Recommendations for restricting availability of codeine-based analgesics are made.