Chronic Nephrotoxicity of Anti-Inflammatory Drugs Used in the Treatment of Arthritis

Abstract

We determined the consumption of non-steroidal anti-inflammatory drugs (NSAIDs) and the prevalence of chronic renal impairment and renal papillary necrosis (RPN) in patients with various types of arthritis. Ninety-four patients with chronic arthritis who had consumed more than 1000 capsules and/or tablets of NSAIDs were studied. Renal profiles and radiological investigations such as intravenous urogram (IVU), ultrasonography (US) and computed tomography (CT) were performed to look for evidence of RPN. Twelve patients did not complete the study. Ten of the 82 patients who had completed the study (12.2%) had radiologic evidence of RPN. Five out of 53 patients (9.4%) with rheumatoid arthritis, three out of 11 patients (27.3%) with gouty arthritis and two out of seven patients (28.6%) with osteoarthritis had RPN. Renal impairment (serum creatinine levels of 125-451 mumol/l) was found in 20 patients (24.4%). The patients had consumed 1000-26,300 capsules and/or tablets over a period ranging from 1 yr to more than 30 yr. Patients with chronic arthritis who consume excessive amount of NSAIDs are at risk of developing RPN and chronic renal impairment.

Renal Papillary Necrosis—40 Years On

“…There are a number of clinical studies that identify RPN to be caused by the long-term use of NSAIDs as the sole or predominant medication (206 …”

“…It is also apparent that the problem of excessive use of analgesics continues today (13,46,56,87,96,171,185,200,201) and this healthcare cost is probably preventable (46,47,59). Analgesic abuse is a frequent cause of analgesic nephropathy that leads to end-stage renal disease and upper urothelial carcinoma throughout Europe (46, 47, 58-64, 179,180,203,204), Australia (149-150, 171, 216), and other parts of the world (206)(207)(208)(209)(210). Interestingly, there are apparently only few cases in the USA (21,29,56,96,184,200,201,226).…”

Improvement of Renal Function in Patients with Chronic Gout after Proper Control of Hyperuricemia and Gouty Bouts

“…The existence of ‘gouty nephropathy’ [1]is nowadays controversial, and most studies suggest that an impaired renal function in patients with gout is related mainly to age [2]and factors considered to increase the risk of vascular involvement such as hypertension, hyperlipemia and diabetes mellitus [3, 4, 5]. Also, patients with gout may be at risk of developing renal disease secondary to the intake of nonsteroidal anti-inflammatory drugs (NSAIDs) [6, 7], especially elderly patients [7]. …”

Kronik bel-boyun ağrılı hastada opioid analjezikler

“…[6] Bu tezi savunan çalışmaların yanı sıra, kısa dönemde NSAİİ'nin etkin, ama uzun süreli kullanım ve aşağıda özetlenen bazı durumlarda kullanımlarının sakıncalı olduğunu savunan görüşler de bulunmaktadır. [7][8][9][10][11][12] Asetaminofen, osteoartrit tedavisinde birinci seçe-nek olarak önerilir, fakat NSAİİ'den daha az etkilidir ve 4 gr'ı aşan dozlarda hepatotoksik etkisi mevcuttur. NSAİİ hafif ve orta dereceli ağrılarda etkindir, fakat bu ilaçların da doz bağımlı gastrointestinal, kardiyovaskü-ler ve renal yan etkileri bulunmaktadır.…”

“…Ciddi gastrointestinal yan etkilerin yanı sıra kronik NSAİİ kullanan hastaların %24'ünde renal disfonksiyon, %12'sinde renal papiller nekroz oluşmakta ve aşırı kullanım-la risk artmaktadır. [7] Aynı zamanda, NSAİİ'nin yaşlı hastalarda çok kullanılan antihipertansifler, warfarin, aspirin gibi ilaçlarla önemli etkileşimleri bulunmaktadır. NSAİİ, diüretiklerin etkinliğini azalttığından, kullanımıyla konjestif kalp yetmezliği riski artmaktadır.…”