Prostaglandins and NSAID in the kidney

In patients with underlying renal impairment, administration of nonsteroidal anti-inflammatory drugs (NSAID) can produce a marked reduction of renal function via inhibition of renal prostaglandin (PG) synthesis. Recent findings indicate that administration of misoprostol can at least partially prevent NSAID induced nephrotoxic effects, suggesting a role for exogenous PG in this setting. These agents may also have important immunomodulatory effects. Other recently reported data show that use of misoprostol in renal transplant patients receiving immunosuppressive therapy with cyclosporine and prednisone was associated with a significant reduction in the incidence of acute graft rejection, as well as improved graft function irrespective of the occurrence of rejection.