Clinical aspects of renal prostaglandins and NSAID therapy

Nonsteroidal antiinflammatory drugs (NSAIDs) can have a variety of effects on renal function. Excluding allergic phenomena, these are directly related to NSAID-induced inhibition of renal synthesis of prostaglandins (PGs). For the most part, renal PGs play important physiological roles only in certain pathologic conditions. Thus, patients without these diseases (such as cardiac, hepatic, or renal compromise) manifest no or only trivial effects on renal function when NSAIDs are administered. This feature is to the advantage of the clinician because it allows prospective identification of patients who are at risk for an adverse renal effect; hence, such effects can be minimized or avoided altogether. To do so requires an understanding of the various roles of PGs in the kidney and thereby the effects that one can observe from NSAIDs. This review focuses on these various roles of renal PGs and on identification of patient groups at risk for adverse renal effects of NSAIDs.