Nonsteroidal Anti-Inflammatory Drugs and Acute Renal Failure in the Elderly

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most valuable groups of available medications because of their effectiveness in relieving pain, particularly that associated with rheumatoid arthritis. They are also among the most commonly prescribed drugs and, because of their availability over-the-counter, they are among the most widely consumed agents, especially by elderly people. Older individuals are more predisposed to the renal adverse effects of NSAIDs, because of: (i) age-associated changes in renal function; (ii) the prevalence of comorbid conditions (congestive heart failure, hypertension, hepatic cirrhosis, renal insufficiency); and (iii) the pervasive use of concomitant drugs that affect kidney function (diuretics, antihypertensives). However, because the incidence of NSAID-induced acute renal failure (ARF) is relatively low, and because it occurs in an identifiable and therefore preventable setting, the benefits of limited NSAID use outweigh the risks of this adverse effect. Using NSAIDs for a restricted period of time at the lowest effective dosage, and informing patients of the conditions in which ARF can occur, should minimise the risk of this effect. If the use of an NSAID in a patient at potential risk of ARF is necessary, close monitoring of renal function should further reduce the already low risk:benefit ratio for this adverse effect.

Measuring quality in arthritis care: The Arthritis Foundation's Quality Indicator set for osteoarthritis

“…A few observational studies have reported an association between acetaminophen and gastrointestinal bleeding (82, 83). Renal toxicity has been reported for NSAIDs, though it is less common than gastrointestinal toxicities (84–91). A few observational studies have reported an association between acetaminophen and renal insufficiency (92–95), although this risk is generally considered low (96).…”

Prostacyclin in endotoxemia-induced acute kidney injury: cyclooxygenase inhibition and renal prostacyclin synthase transgenic mice

“…PGIs expression also occurs in the endothelium, and PGI 2 has been shown to increase during renal ischemia and cause renal vasodilation (8). Since a decrease in PGI 2 by inhibition of COX can be deleterious to renal function in settings in which renal vasoconstriction already exists, such as congestive heart failure (25) and cirrhosis (1,5,16), the potential role of PGI 2 in endotoxemia-related AKI was investigated.…”

Treatment of Rheumatic Diseases Interrelation of Selective Non-Steroidal Antiinflammatory Drug Celebrex (Celecoxib) and Inhibitor of Enzyme With Apf Enap (Enalapr1l) in Patients With Rheumatic Diseases and Concomitant Arterial Hypertension

“…Ряд авторов также приво дят данные, что пожилые люди чаще подвержены почечным побочным эффектам НПВП, потому что у них происходят возраст-зависимые изменения в органах выделения, чаще развивается застойная сердечная недостаточность, гипертензия, цирроз печени, почечная недостаточность. Пожилым пациентам чаще на значают комбинацию лекарственных средств, таких как ги потензивные и диуретики [2,19,26,36]. Эти данные касались использования традиционных препаратов: индометацин, диклофенак, ибупрофен.…”