Renal
NSAID Renal Adverse Effects
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NSAID Renal Adverse Effects
, Nephrotoxicity due to NSAIDs
See Also
NSAID
NSAID
Alternatives
Nephrotoxicity
Epidemiology
NSAID
s are top cause of
Renal Insufficiency
in elderly
Physiology
NSAID
s decrease synthesis of renal prostaglandins
Prostaglandins vasodilate renal vessels
NSAID
s therefore reduce renal
Blood Flow
Risk Factors
NSAID
related
Acute Renal Failure
Elderly
Hypovolemia
Ineffective circulation
Congestive Heart Failure
Cirrhosis
Nephrotic Syndrome
Concurrent medications
ACE Inhibitor
Angiotensin Receptor Blocker
(ARB)
Diuretic
s
Adverse Effects
Gene
ral Renal effects
NSAID
Related Fluid and
Electrolyte
abnormalities
Edema
Hyperkalemia
Acute Renal Failure
Acute papillary Necrosis
Management
Practice Guidelines for
NSAID
use in the elderly
Establish a definitive treatment diagnosis
Inflammatory condition (e.g.
Rheumatoid Arthritis
)
NSAID
indicated
COX2 Inhibitor
offers no advantage regarding nephrotoxicity
Non-Inflammatory condition
NSAID
alternative medication (e.g.
Tylenol
)
Perform baseline
Renal Function
and repeat q3-12 months
See
NSAID
s for lab monitoring
Creatinine
Consider screening for
Proteinuria
Choose
NSAID
with high benefit to risk ratio (e.g. Sulindac)
Good efficacy
Lower renal toxicity
Avoid the most
NSAID
S 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
NSAID
s in reduced renal perfusion
Avoid
NSAID
s with
ACE Inhibitor
s or
Angiotensin Receptor Blocker
s
Avoid
NSAID
s with
Diuretic
s
Avoid
NSAID
s in
Dehydration
Avoid combinations predisposing to
Hyperkalemia
Avoid
NSAID
with
Potassium
sparing
Diuretic
Avoid
NSAID
with
ACE Inhibitor
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