An association between non-opioid analgesic agents and chronic kidney disease has long been suspected. The presumed development of chronic renal impairment following protracted excessive use of non-opioid analgesia is known as analgesic nephropathy. Many accept analgesic nephropathy as a real entity despite a paucity of robust scientific evidence. The weight of available observational literature suggests that long-term ingestion of paracetamol and combination mixtures of aspirin and paracetamol probably contribute to chronic renal impairment, however there is no convincing data to implicate non-steroidal anti-inflammatory drugs or aspirin monotherapy. While controversy persists most physicians consider all non-narcotic analgesics nephrotoxic and discourage heavy use where possible.