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NSAID Renal Adverse EffectsAka: Nephrotoxicity due to NSAIDs
- See Also
- NSAID
- NSAID Alternatives
- Epidemiology
- NSAIDs are top cause of renal insufficiency in elderly
- Physiology
- NSAIDs decrease synthesis of renal prostaglandins
- Prostaglandins vasodilate renal vessels
- NSAIDs therefore reduce renal blood flow
- Risk Factors for NSAID related Acute Renal Failure
- Elderly
- Hypovolemia
- Ineffective circulation
- Congestive Heart Failure
- Cirrhosis
- Nephrotic Syndrome
- Concurrent ACE Inhibitor use
- General Renal effects
- NSAID Related Fluid and Electrolyte abnormalities
- Edema
- Hyperkalemia
- Acute Renal Failure
- Acute papillary Necrosis
- Practice Guidelines for NSAID use in the elderly
- Establish a definitive treatment diagnosis
- Inflammatory condition (e.g. Rheumatoid Arthritis)
- NSAID indicated
- Consider COX2 Inhibitor instead (Celebrex, Vioxx)
- These are however also nephrotoxic
- Non-Inflammatory condition
- NSAID alternative medication (e.g. Tylenol)
- Perform baseline Renal Function and repeat q3-12 months
- See NSAIDs for lab monitoring
- Creatinine
- Consider Urine Collection for 24 hours
- Creatinine Clearance
- Urine Protein
- Choose NSAID with high benefit to risk ratio (Sulindac)
- Good efficacy
- Lower renal toxicity
- Avoid the most NSAIDS most commonly associated with nephrotoxicity
- Ketorolac (Toradol)
- Indomethacin
- Begin with lowest NSAID dose and use the lowest effective dose
- Consider Gastric protection or COX2 Inhibitor
- See NSAID Gastrointestinal Adverse Effects
- Continue to monitor efficacy and side effects
- Do no harm
- Avoid combining high risk medications
- Avoid using NSAID with another NSAID
- Avoid combinations predisposing to Hyperkalemia
- Avoid NSAID with potassium sparing Diuretic
- Avoid NSAID with ACE Inhibitor
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