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COX-2 inhibitors and the kidney
1Columbia Presbyterian Medical Center, New York, USA. nephroman@email.msn.com
Clinical and Experimental Rheumatology
|November 7, 2001
Summary
Selective cyclooxygenase-2 (COX-2) inhibitors offer anti-inflammatory benefits but can cause renal side effects like other nonsteroidal anti-inflammatory drugs (NSAIDs). Careful use in high-risk patients minimizes these adverse renal events.
Area of Science:
- Pharmacology
- Nephrology
- Rheumatology
Background:
- Selective cyclooxygenase-2 (COX-2) inhibitors are widely used for anti-inflammatory and analgesic effects, with fewer gastrointestinal side effects than traditional NSAIDs.
- Initial hopes for reduced renal toxicity due to COX-2 enzyme localization in the kidney have not been fully realized.
Purpose of the Study:
- To evaluate the renal side effect profile of COX-2 inhibitors compared to other NSAIDs.
- To assess the incidence and impact of renal adverse events associated with COX-2 inhibitor use.
Main Methods:
- Review of evidence from large controlled trials and subsequent studies on COX-2 inhibitor use.
- Analysis of documented renal effects, including salt/water retention, hypertension, and acute kidney injury.
Main Results:
- COX-2 inhibitors, like other NSAIDs, can cause salt and water retention, edema, and hypertension.
- Acute declines in renal function and glomerular filtration rate can occur but are uncommon in rheumatology populations.
- Adverse renal events infrequently lead to medication discontinuation.
Conclusions:
- COX-2 inhibitors are associated with renal side effects similar to other NSAIDs.
- Judicious use in high-risk patients, including those with renal insufficiency, diabetes, or heart failure, can decrease the incidence of adverse renal events.