Related Experiment Video
Updated: Aug 26, 2026
Intravascular Delivery of Biologics to the Rat Kidney
Published on: September 1, 2016
Opioids and renal function
Sebastiano Mercadante1, Edoardo Arcuri
1Pain Relief and Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy. terapiadeldolore@la-maddalena.it
Unlabelled:
Opioids, both endogenous and exogenous, have a strong influence on the renal function through different mechanisms, producing changes in the renal excretion of water and sodium. Several studies have demonstrated that opioids influence renal function, according to the agonist profile used. Mu, kappa, and delta agonists produce different renal effects, although the mechanisms remain unclear. Experimental data have given the input for a possible therapeutic role of kappa agonists for some specific conditions, for example, in treating water retention or hyponatremia occurring in patients who have hepatic cirrhosis with ascites. On the other hand, changes in renal function might strongly condition the use of opioids in the clinical setting, and the knowledge of the relationship between opioids and renal function is mandatory for a tailored approach to accommodate the individual responses in terms of pain intensity, tolerance, and adverse effects experienced by these groups of patients. The influence of renal function when using different opioids in the clinical setting is reviewed, as well as problems related to transplantation, renal damage induced by opioid addiction, and problems related to the use of opioid antagonists in such conditions.
Perspective:
Endogenous opioids exert physiologic effects on renal function, and the use of opioids may have an influence on renal activity. Renal impairment has a serious impact on the clearance of most opioids used in the clinical setting. Biochemical and clinical monitoring is mandatory to prevent serious complications.
Insights
Opioids significantly impact kidney function, affecting water and sodium excretion. Understanding this relationship is crucial for safe opioid use, especially in patients with impaired renal function.
Area of Science:
- Pharmacology
- Nephrology
- Renal Physiology
Background:
- Opioids, both internal and external, significantly affect kidney function through various mechanisms, altering water and sodium excretion.
- Different opioid receptor agonists (mu, kappa, delta) elicit distinct renal responses, though underlying mechanisms require further elucidation.
Purpose of the Study:
- To review the influence of renal function on the clinical use of different opioids.
- To discuss challenges related to opioid use in patients with kidney issues, including transplantation and opioid-induced renal damage.
Main Methods:
- Review of experimental data and existing literature on opioid-renal interactions.
- Analysis of clinical implications for pain management and adverse effect mitigation.
Main Results:
- Opioid administration influences renal excretion of water and sodium.
- Kappa agonists show potential therapeutic applications for fluid retention in conditions like hepatic cirrhosis.
- Renal impairment critically affects the clearance of commonly used opioids.
Conclusions:
- Endogenous opioids play a physiological role in renal function; exogenous opioid use impacts renal activity.
- Close biochemical and clinical monitoring is essential to prevent severe complications in patients using opioids with renal impairment.
Related Concept Videos
01:20Opioid Analgesics: Morphine and Other Natural Cogeners
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:25Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant
01:15Renal Drug Excretion: Overview
A nephron consists of two primary structures: the renal corpuscle and the renal tubule. The renal corpuscle contains the glomerulus, a network of capillaries where the first step of renal excretion, glomerular filtration, occurs. Blood pressure forces water, ions, and small molecules out...