Kidneys nonsteroidal anti-inflammatory

The nonsteroidal anti-inflammatory agents must be used with special care in the geriatric patient because they cause toxicities to which the elderly are very susceptible. In the case of aspirin, the most important of these is gastrointestinal irritation and bleeding. In the case of the newer NSAIDs, the most important is renal damage, which may be irreversible. Because they are cleared primarily by the kidneys, these drugs will accumulate more rapidly in the geriatric patient and especially in... 

Tarako et al. (1991) evaluated oxygen supply and energy state in the isolated perfused rat kidney. Metabolic activities of the isolated perfused rat kidney were described by Nishiitsutsuji-Uwo et al. (1967). Cox et al. (1990) used the isolated perfused rat kidney as a tool in the investigation of renal handling and effects of nonsteroidal anti-inflammatory drugs. 

Figure 38.1. Sites of renal damage, including factors that contribute to the kidney s susceptibility to damage. ACE - angiotensin converting enzyme NSAID-nonsteroidal anti-inflammatory drugs HgCl2 - mercuric chloride (adapted from Color Atlas of the Diseases of the Kidney, Vol. 1, Berl, T., Bonventre, J.V., 1998, with permission).

P-adrenoceptor blockers lose some antihypertensive efficacy when nonsteroidal anti-inflammatory drugs (NSAIDs), especially indomethacin, are coadministered the effect involves inhibition of production of vasodilator prostaglandins by the kidney leading to sodium retention. 

Kleinknecht D. Diseases of the kidney caused by nonsteroidal anti-inflammatory drugs. In. Stewart JEI (editor). Oxford University Press, Oxford 1993 p. 160-173. 

Wen SF, Parthasarathy R, lliopoulos 0,OberleyTD. Acute renal failure following binge drinking and nonsteroidal anti-inflammatory drugs. Am J Kidney Dis 1992 20 281-285. 

De long PE, Statius van Eps LW. Sickle cell nephropathy new insights into its pathophysiology. Kidney Int 1985 27 711-719. Allen M, Lawson L, Eckman IR, Delaney V, Bourke E. Effects of nonsteroidal anti-inflammatory drugs on renal function in sickle cell anemia. Kidney Int 1988 34 500-506. 

Nierenberg DW. Competitive inhibition of methotrexate accumulation in rabbit kidney slices by nonsteroidal anti-inflammatory drugs. J Pharmacol ExpTher 1983 226 1-6. 

Ibanez L, Morlans M, Vidal X, Martinez MJ, Laporte JR. Case-control study of regular analgesic and nonsteroidal anti-inflammatory use and end-stage renal disease. Kidney Int 2005 67(6) 2393-8. 

Bennett WM, Henrich WL, Stoff JS, Bennett WM, Henrich WL, Stoff JS.The renal effects of nonsteroidal anti-inflammatory drugs summary and recommendations. American Journal of Kidney Diseases 1996,-28 S56-S62. 

Schlondorff D, Schlondorff D. Renal complications of nonsteroidal anti-inflammatory drugs. Kidney International 1993 44 643-653. 

SturmerT, Elseviers MM, De Broe ME, SturmerT, Elseviers MM, De Broe ME. Nonsteroidal anti-inflammatory drugs and the kidney. 

ACE inhibitors are well tolerated in most patients but are not absent of side effects. ACE inhibitors decrease aldosterone and can increase potassium serum concentrations. Usually the increase in potassium is small, but hyperkalemia is possible. It is seen primarily in patients with chronic kidney disease or diabetes mellitus and in those on concomitant ARBs, nonsteroidal anti-inflammatory drugs, potassium supplements, or potassium-sparing diuretics. Judicious monitoring of potassium and serum creatinine values within 4 weeks of starting or increasing the dose of an ACE inhibitor often can identify these abnormalities before they evolve into more serious complications. 

Walker RG. Lithium nephrotoxicity. Kidney Int Suppl 1993 42 S93-S98. LamSS, Kjellstrand C. Emergency treatment of lithium-induced diabetes insipidus with nonsteroidal anti-inflammatory drugs. Ren Eail 1997 19 183-188. 

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