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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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An Old Enemy: Still Nephrotoxic.

Faruk Recep Ozalp1, Tugba Karadeniz2, Alper Alp3

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Diclofenac can cause acute tubulointerstitial nephritis (TIN), which may resolve but can recur and progress to chronic TIN if the drug is reintroduced. This highlights NSAID nephrotoxicity.

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Area of Science:

  • Nephrology
  • Pharmacology
  • Internal Medicine

Background:

  • Tubulointerstitial nephritis (TIN) is characterized by inflammation and fibrosis of renal tubules and interstitium, with diverse causes.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are a known cause of acute kidney injury, including TIN.

Observation:

  • A 44-year-old male presented with acute TIN attributed to therapeutic doses of diclofenac.
  • The acute TIN resolved with treatment, but recurred and progressed to chronic TIN upon diclofenac re-exposure.

Findings:

  • This case demonstrates a direct link between diclofenac use and reversible acute TIN.
  • Recurrence and progression to chronic TIN underscore the cumulative nephrotoxic potential of NSAIDs.

Implications:

  • Clinicians should consider NSAIDs, such as diclofenac, in the differential diagnosis of acute kidney injury.
  • Patient education regarding NSAID risks and careful monitoring are crucial to prevent chronic kidney disease progression.