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NSAIDs and kidney.

P Ejaz¹, K Bhojani, V R Joshi

¹PD Hinduja National Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai.

The Journal of the Association of Physicians of India

|April 26, 2005

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Nonsteroidal anti-inflammatory drugs (NSAIDs) can harm kidneys by inhibiting prostaglandin synthesis, potentially causing acute kidney injury and chronic renal failure. A kidney-safe NSAID has not yet been developed.

Area of Science:

Nephrology
Pharmacology

Background:

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for pain and inflammation.
Despite the development of selective COX-2 inhibitors, NSAID-induced nephrotoxicity remains a significant clinical concern.
NSAID adverse effects on the kidney are primarily mediated by inhibiting prostaglandin synthesis via cyclooxygenase blockade.

Purpose of the Study:

To review the mechanisms of NSAID-induced nephrotoxicity.
To discuss the spectrum of renal damage caused by NSAIDs, from reversible impairment to chronic renal failure.
To highlight the persistent risk of renal dysfunction associated with NSAID use.

Main Methods:

Literature review of studies on NSAID pharmacology and renal effects.
Analysis of clinical case reports and epidemiological data on NSAID-associated kidney injury.

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Examination of pathophysiological mechanisms underlying NSAID nephrotoxicity.

Main Results:

NSAID use can lead to vasoconstriction and renal impairment, particularly in volume-depleted states, potentially causing acute tubular necrosis and acute renal failure.
NSAIDs are associated with interstitial nephritis, minimal change disease, nephrotic syndrome, and papillary necrosis, which can progress to chronic renal failure.
Subclinical renal dysfunction, including reduced creatinine clearance and impaired urine concentrating ability, is common in long-term NSAID users and may persist even after drug withdrawal.

Conclusions:

NSAID-induced nephrotoxicity encompasses a range of renal pathologies, from acute reversible injury to progressive chronic kidney disease.
Current NSAIDs, including selective COX-2 inhibitors, do not offer a "renal-safe" option.
Ongoing vigilance and consideration of renal function are crucial for patients using NSAIDs, especially long-term.