Effects of nonsteroidal anti-inflammatory drugs on renal function: focus on cyclooxygenase-2-selective inhibition

Nonsteroidal anti-inflammatory drugs (NSAIDs) can affect renal function in a variety of ways. The most important clinical effects are decreased sodium excretion, decreased potassium excretion, and declines in renal perfusion. Decreased sodium excretion can result in weight gain, peripheral edema, attenuation of the effects of antihypertensive agents, and rarely precipitation of chronic heart failure. Hyperkalemia can occur to a degree sufficient to cause cardiac arrhythmias. Renal function can decline sufficiently enough to cause acute renal failure. Risk factors for all of these effects have been identified, allowing prospective identification of patients at risk with institution of appropriate precautionary measure. All NSAIDs seem to share these adverse effects. Preliminary data from cyclooxygenase-2-selective inhibitors suggest that they also affect renal prostaglandins. Therefore, the same cautions should be exercised with their use as with traditional NSAIDs.