Piroxicam-induced renal disease.

Area of Science:

• Nephrology
• Immunology
• Pharmacology

Background:

• Piroxicam, a nonsteroidal anti-inflammatory drug (NSAID), is widely used for pain and inflammation.
• NSAIDs, including piroxicam, exert their effects by inhibiting prostaglandin synthesis.
• Potential adverse effects on renal function are a known concern with NSAID use.

Observation:

• Two distinct cases of piroxicam-induced nephrotoxicity are presented.
• Case 1: Severe, reversible azotemia and hyperkalemia developed during piroxicam treatment.
• Case 2: Acute interstitial nephritis with glomerulonephritis and hepatitis was diagnosed via biopsy.

Findings:

• Discontinuation of piroxicam led to the resolution of azotemia and hyperkalemia in the first case.
• Steroid therapy resulted in improvement of renal and hepatic parameters in the second case.
• These findings highlight the diverse renal manifestations of piroxicam toxicity.

Implications:

• Piroxicam can induce significant nephrotoxicity through various mechanisms, potentially involving hemodynamic, cellular, or humoral pathways.
• Early recognition and management, including drug withdrawal or immunosuppressive therapy, are crucial for favorable outcomes.
• Further research into the immunopathogenesis of NSAID-induced kidney injury is warranted.