Nephrotoxicity of nonsteroidal anti-inflammatory drugs: Physiologic foundations and clinical implications

Andrew Whelton

Research output: Contribution to journalArticle

Abstract

Although the prevalence of nephrotoxicity in patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs) is relatively low, the extensive use profile of these agents implies that many persons are at risk. At basal states of normal renal function, the role of renal prostaglandin production for maintenance of stable renal hemodynamic function is relatively limited. Nonetheless, in the clinical setting of reduced renal perfusion as seen in various forms of cardiorenal disease, dehydration, and the aging kidney, the adequacy of renal prostaglandin production mediated predominantly by cyclooxygenase-1 (COX-1) and, potentially, by COX-2 enzyme activity becomes of major significance in the activation of compensatory renal hemodynamics. Inhibition of renal prostaglandin production by the use of NSAIDs in these circumstances can potentially lead to the emergence of several distinct syndromes of disturbed renal function. These include fluid and electrolyte disorders, acute renal dysfunction, nephrotic syndrome/interstitial nephritis, and renal papillary necrosis. In addition, by blunting the homeostatic renal effects of prostaglandins, NSAIDs can adversely influence blood pressure control, particularly during the use of angiotensin-converting enzyme (ACE) inhibitors, diuretics, and β blockers. This is a matter of considerable public health concern, in that some 12 million US citizens are concurrently treated with NSAIDs and antihypertensive drugs. Finally, the risk of congestive heart failure is significantly increased when NSAIDs are given to patients receiving diuretic therapy who have cardiovascular risk factors. Physiologic factors, clinical presentations, diagnostic modalities, and clinical management strategies appropriate to these NSAID-induced renal syndromes are described.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
Volume106
Issue number5 B
DOIs
StatePublished - May 31 1999

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Anti-Inflammatory Agents
Kidney
Pharmaceutical Preparations
Prostaglandins
Diuretics
Hemodynamics
Interstitial Nephritis
Cyclooxygenase 1
Nephrotic Syndrome
Dehydration
Angiotensin-Converting Enzyme Inhibitors
Antihypertensive Agents
Electrolytes
Necrosis
Heart Failure
Public Health
Perfusion
Maintenance
Blood Pressure
Enzymes

ASJC Scopus subject areas

  • Nursing(all)

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Nephrotoxicity of nonsteroidal anti-inflammatory drugs : Physiologic foundations and clinical implications. / Whelton, Andrew.

In: American Journal of Medicine, Vol. 106, No. 5 B, 31.05.1999.

Research output: Contribution to journalArticle

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