Title:Prevention of Renal Complications Induced by Non- Steroidal Anti-Inflammatory Drugs
Volume: 23
Issue: 19
Author(s): Sonja Vučković, Katarina Savić Vujović, Dragana Srebro, Branislava Medić and Tatjana Ilic-Mostic
Affiliation:
Keywords:
Non-steroidal anti-inflammatory drugs, adverse effects, kidney, hypertension, acute kidney injury,
chronic kidney disease, acute interstitial nephritis.
Abstract: Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed
for the treatment of pain, inflamation and fever. They are usually well
tolerated in healthy persons, but in patients with risk factors (advanced age, renal
impairment, heart failure, liver disease, concurrent medications with antihypertensive
drugs), NSAIDs can induce serious renal adverse effects. They include
sodium and water retention with edema, worsening of heart failure, hypertension,
hyponatremia, hyperkalemia, acute kidney injury, chronic kidney disease,
renal papillary necrosis and acute interstitial nephritis. The majority of
these adverse effects are due to the inhibition of prostaglandins synthesis and
they are dose and duration-dependent. Acute forms of kidney injuries are transient
and often reversible upon drug withdrawal. Chronic use of NSAIDs in some
patients may result in chronic kidney disease. It is recommended that patients at risk should have
preventative strategies in place, including the use of the “lowest effective dose” of NSAID for the
“shortest possible time” and monitoring renal function, fluid retention and electrolyte abnormalities.
Patients who are taking antihypertensive medications should be monitored for high blood
pressure and the doses of antihypertensive medications should be adjusted if needed. In general,
the combination of NSAIDs and angiotensin inhibitors should be avoided. Some other preventive
measures are dietary salt restriction, use of topical NSAIDs/non-pharmacological therapies and
use of calcium channel blockers for treating hypertension.
