Renal insufficiency associated with nonsteroidal anti-inflammatory agents

Area of Science:

• Nephrology
• Pharmacology
• Internal Medicine

Background:

• Nonsteroidal anti-inflammatory agents (NSAIDs) are widely used for pain and inflammation management.
• NSAIDs are known to potentially cause renal adverse effects, but the clinical spectrum is not fully characterized.
• Patients experiencing hemodynamic stress may be at higher risk for NSAID-induced kidney injury.

Purpose of the Study:

• To characterize the clinical spectrum of renal insufficiency associated with NSAID use.
• To identify risk factors and clinical outcomes in patients developing renal insufficiency due to NSAIDs.
• To assess the incidence and severity of NSAID-induced renal insults.

Main Methods:

• Retrospective analysis of 26 patients with 27 episodes of renal insufficiency linked to NSAID use over 27 months.
• Data collection included serum creatinine, serum urea nitrogen, duration of NSAID therapy, and time to renal function recovery.
• Clinical characteristics, including hemodynamic status and presence of hyperkalemia, were reviewed.

Main Results:

• Mean serum creatinine increased from 1.6 to 3.3 mg/dL and returned to 1.7 mg/dL post-discontinuation.
• Mean serum urea nitrogen increased from 27.8 to 54.5 mg/dL and returned to 31.0 mg/dL.
• Five patients experienced brief oliguria; no patient required dialysis. Six patients developed hyperkalemia, one with life-threatening levels (7.9 mEq/L).

Conclusions:

• NSAID-induced renal insufficiency is generally mild and rapidly reversible upon drug cessation.
• Patients with hemodynamic stress are at increased risk for significant renal impairment.
• Hyperkalemia is a frequent and potentially severe complication, disproportionate to the degree of renal insufficiency.