Systemic lupus erythematosus NSAIDs

The nonsalicylate NSAIDs can also affect renal function. Risk factors fc>r NSAID-induced acute renal failure include congestive heart feilure, glomerulonephritis, chronic renal insufficiency, cirrhosis, systemic lupus erythematosus, diabetes mellitus, significant atherosclerotic disease in the elderly and use of diuretics. NSAIDs can adversely affect cardiovascular homeostasis and can be a risk factor for the onset or exacerbation of heart feilure. 

Some rarer adverse effects, such as aseptic meningitis, have been reported with ibuprofen, suhndac, and tolmetin (37) in patients with systemic lupus erythematosus. A case-control study showed no increased risk of intracerebral hemorrhage in patients using aspirin or other NSAIDs in low dosages as prophylaxis against thrombosis (43). 

Like other NSAIDs, suhndac can cause aseptic meningitis in patients with systemic lupus erythematosus (SEDA-7, 109). Recurrent aseptic meningitis, described in a patient with no underlying connective tissue disease who had tolerated other NSAIDs, suggested immunological hypersensitivity to sulindac (10). 

Persons at greatest risk for NSAID hemodynamic nephropathy generally have pre-existing renal insufficiency, medical problems associated with high plasma renin activity (hepatic disease with ascites, decompensated congestive heart failure, or intravascular volume depletion), or systemic lupus erythematosus. Additional risk factors include atherosclerotic cardiovascular disease and diuretic therapy. The elderly are also at higher risk due to interaction of prevalent medical problems, multiple drug therapies, and reduced renal hemodynamics. Advanced age, however, has not been shown to be an independent risk factor for toxicity in limited trials in otherwise healthy elderly subjects. Combined NSAID and ACEl or ARB therapy is also a concern and should be avoided. 

The female client diagnosed with systemic lupus erythematosus (SLE) complains to the nurse that she has pain she is stiff when she gets up in the morning and she takes ibuprofen, an NSAID, to help ease the pain and stiffness. Which question is most important for the nurse to ask the client ... 

The clearance of a single oral dose of sodium valproate was reduced in 6 patients by 2 to 17% after a 4-week course of cimetidine, but was not affected by ranitidine. It seems doubtful if the interaction between valproate and cimetidine is of clinical importance. However, a case of fatal hyperammonaemia in a patient with systemic lupus erythematosus was speculated to have been induced by valproate, and the authors also considered that the concurrent use of cimetidine and aspirin (see Valproate + Aspirin or NSAIDs , p.575) may have contributed. The general importance of this case is unknown. 

Patients with chronic parenchymal renal disease show a fall in RBF and GFR during treatment with NSAID, including aspirin . In chronic glomerulonephritis, afferent arteriolar dilatation may be a compensatory mechanism in the maintenance of filtration. A study of patients with systemic lupus erythematosus revealed an abnormal increase in basal PGE2 excretion consistent with the postulated means of compensation. In other aetiologies of renal insufficiency, including diabetes, hypertension and interstitial nephritis, there is acute worsening of renal function with NSAID " ... 

Hypersensitive reactions to drugs are frequently observed in patients with systemic lupus erythematosus. It has become evident in recent years that NSAID are no exception to this rule. 

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