Kidney NSAIDs =analgesic

The chronic progression of events that lead to NSAID/analgesic related papillary necrosis are well known since the days of the first descriptions of chronic combined analgesics abuse nephropathy and the subsequent extensive investigations which defined the consequences of chronic (5-20 years) exposure of the kidney to high doses of analgesic combinations such as salicylate and acetaminophen (the metabolite of phenacetin) often with the addition of caffeine [106]. 

Ibuprofen is the most thoroughly researched 2-ary lpropionic acid. It is a relatively weak, non-selective inhibitor of COX. In epidemiological studies, ibuprofen compared to all other conventional NSAIDs, has the lowest relative risk of causing severe gastrointestinal side effects. Because of this, ibuprofen is the most frequently used OTC ( over the counter , sale available without prescription) analgesic. Ibuprofen is highly bound to plasma proteins and has a relatively short elimination half-life ( 2 h). It is mainly glucuronidated to inactive metabolites that are eliminated via the kidney. 

Acetaminophen may worsen kidney function and increase blood pressure.1516 Nevertheless, acetaminophen remains the preferred analgesic for mild to moderate pain in patients with hypertension or kidney disease owing to the greater risks associated with NSAID use.17 Monitoring specifically for these toxicities generally is unnecessary. 

NSAIDs exert analgesic, antipyretic, anti-inflammatory and related effects. During pain, fever and inflammation the arachi-donic acid is liberated from the phospholipid fraction of the cell membrane which is then converted to prostaglandins (PCs) via cyclooxygenase pathway (both COX-1 COX-2). COX-1 is present in kidney, stomach and blood vessels and COX-2 is present in activated leukocytes and other inflammatory cells. 

NITRATES ANALGESICS-NSAIDS Hypotensive effects of hydralazine, minoxidil and nitroprusside antagonized by NSAIDs NSAIDs cause sodium and water retention in the kidney and can raise BP due to 1 production of vasodilating renal prostaglandins Monitor BP at least weekly until stable... 

The co-administration of more than one NSAID does not produce synergism of the analgesic effect but significantly increases the risk of gastrointestinal toxicity and liver and kidney damage so should be avoided. 

Pommer W. Clinical presentation of analgesic-induced nephropathy. In Analgesic and NSAID-induced kidney disease. Stewart JH (editor). Oxford University Press, Oxford 1993 p. 108-118. 

The National Kidney Foundation strongly discourages the use of over-the-counter combination analgesic products (e.g., acetaminophen and NSAIDs) because this is associated with an increased prevalence of renal failure. Finally, patients should be warned about potential toxicity if they inadvertently ingest more than the recommended dose when using both nonprescription and prescription products containing acetaminophen. 

Nanra RS, Kincaid-Smith P. Experimental evidence for nephrotoxicity of analgesics. In Analgesic and NSAID-induced kidney... 

Oxyphenbutazone, a NSAID (300 to 600 mg/day in divided doses), is indicated in pain and inflammation of arthritis and ankylosing spondylitis. Oxyphenbutazone, a metabolite of phenylbutazone, has analgesic, antipyretic, antiinflammatory, and uricosuric properties. Oxyphenbutazone is absorbed orally, is bound to plasma proteins to the extent of 98%, has a half-life of 50 to 100 hours, is metabolized in the liver, and is excreted by the kidneys. Oxyphenbutazone is contraindicated in patients with known hypersensitivity to phenylbutazone in patients in whom aspirin or other NSAIDs induce symptoms of asthma, urticaria, or rhinitis in patients under age 14 because safety has not been established and in patients... 

Acute pain is the presence of severe discomfort or an uncomfortable sensation that has a sudden onset and subsides with treatment. For example, a fractured bone causes acute pain since the uncomfortable sensation occurs suddenly when the bone is broken and subsides when the bone is immobilized in a cast. Pain associated with myocardial infarction (heart attack), appendicitis, and kidney stones are also examples of acute pain. Acute pain can be treated with NSAIDs or opioid analgesics. 

A meta-analysis of chondroitin sulfate supplementation found 16 publications that fit criteria for inclusion. Criteria included types of joint involvement smdied, study designs, numbers of patients emolled, and pain index variables analyzed.It was concluded that chondroitin sulfate may be useful in osteoarthritis treatment however, results of the published smdies were clouded by concomitant use of analgesics or NSAIDs, thus making conclusions about benefits difficult. Some have suggested that it can be used as an anti-inilammatory without dangerous effects on the stomach, platelets, and kidneys. ... 

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