[Nonsteroidal antirheumatics and the kidney]

Area of Science:

• Nephrology
• Pharmacology

Context:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed.
• Renal side effects are a common concern with NSAID use, affecting approximately 5% of patients.
• NSAID-induced kidney injury manifests in various clinical syndromes.

Purpose:

• To review the spectrum of renal side effects associated with NSAIDs.
• To discuss the classification of NSAID-related kidney syndromes.
• To evaluate the renal effects of selective COX-2 inhibitors.

Summary:

• NSAIDs can lead to five main renal syndromes: acute renal failure, acute interstitial nephritis with nephrotic syndrome, electrolyte and fluid disorders, hypertension, and analgesic nephropathy.
• Evidence suggests that selective COX-2 inhibitors, such as rofecoxib and celecoxib, exert comparable renal effects to traditional NSAIDs that inhibit both COX-1 and COX-2.
• The prevalence of NSAID-induced renal adverse events is significant, highlighting the need for careful patient monitoring.

Impact:

• Clinicians should be aware of the potential renal toxicity of NSAIDs, including selective COX-2 inhibitors.
• Understanding these syndromes aids in early diagnosis and management of NSAID-related kidney injury.
• This review underscores the importance of risk-benefit assessment when prescribing NSAIDs.