Previously, we have discussed NSAIDS and cardiovascular risk as well as NSAIDS and gastrointestinal complications .
Previously, we have discussed NSAIDS and cardiovascular risk as well as NSAIDS and gastrointestinal complications . In this post, we’re going to review the literature on NSAIDS and renal complications. To summarize from the previous discussion, NSAIDS are one of the most commonly used drugs in the world and their use is increasing in the US and globally.
In 2013, NSAIDs had accounted for more than 70 million prescriptions and 30 billion over-the-counter purchases. Sports medicine physicians should be cognizant of potential complications, especially nephrotoxicity. Acute kidney injury (AKI) is a major cause of morbidity and mortality.
In individuals admitted to the hospital with AKI requiring emergent dialysis, mortality rates can exceed 50% [ 1 ]. Awareness can lead to better prescribing practices and increased safety for at-risk patients.Cyclooxygenase enzymes, which regulate the conversion of arachidonic acid to prostaglandins, are abundantly present in the kidneys and play an important role in renal hemostasis, renin release, renal tubular salt and water reabsorption. COX-1 “predominates in vascular smooth muscle and collecting ducts, whereas COX2 predominates in the macula densa and nearby cells in the cortical thick ascending limb” [ 2 ].
In general, NSAIDs block the vasodilatory effects of prostaglandins. Nearly all drugs are excreted via the kidneys, and the rate of drug induced nephropathy is increasing [ 3 ]. A decline in renal function can occur within days of initiation of NSAID therapy [ 4 ].
Non-selective NSAIDS and selective COX-2 inhibitors appear to carry similar risks [ 5 ]. In the UK, over 50% of elderly patients with CKD are prescribed NSAIDs with low-dose aspirin accounting for the majority of prescriptions [ 6 ]. It appears that NSAID use may be safe in healthy individuals without any underlying chronic kidney disease.
If you are experiencing symptoms that may be related to nsaids and renal complications, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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