Chapter

NSAID nephrotoxicity

Wai Y. Tse and Dwomoa Adu

in Rheumatology and the Kidney

Second edition

Published on behalf of Oxford University Press

Published in print April 2012 | ISBN: 9780199579655
Published online February 2013 | e-ISBN: 9780191763472 | DOI: http://dx.doi.org/10.1093/med/9780199579655.003.0136

Series: Oxford Clinical Nephrology Series

NSAID nephrotoxicity

Show Summary Details

Preview

1. Although uncommon, the widespread use of NSAIDs means that renal complications are likely to be seen frequently. 2. Two isoforms of COX (COX-1 and COX-2) have been identified in mammalian cells. COX-1, which is constitutively expressed, mediates gastric cytoprotection and vascular homeostasis. COX-2 expression is regulated by salt and water intake, medullary tonicity, growth factors, cytokines and adrenal steroids and produces prostaglandins in inflamed tissues. 3. Constitutive COX-2 mRNA, as well as inducible COX-2 mRNA, is present in the kidney. 4. In circumstances where there is poor renal perfusion with high renin levels, non-selective and COX-2 selective NSAIDs can reduce glomerular filtration rate resulting in acute renal failure. 5. Acute renal failure and hyperkalaemia have been observed after the administration of COX-2 selective inhibitors to patients with risk factors for NSAID-induced acute renal insufficiency. 6. NSAIDs of different chemical classes have been associated with acute tubulo-interstitial nephritis and renal failure. 7. On balance, it seems likely that chronic usage of NSAIDs may be associated with a slightly increased risk for the development of chronic renal failure. 8. Both non-selective NSAIDs and COX-2 inhibitors can raise blood pressure especially in hypertensive, elderly patients and there is no substantial evidence to suggest that COX-2 inhibitors are safer in this respect.

Chapter.  7890 words.  Illustrated.

Subjects: Nephrology

Full text: subscription required

How to subscribe Recommend to my Librarian

Buy this work at Oxford University Press »

Users without a subscription are not able to see the full content. Please, subscribe or login to access all content.