NSAID nephropathy

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Therefore NSAID Nephropathy is damage to the kidney as a result of taking NSAID drugs.

Symptoms

Epidemiology

Epidemiology is the scientific study of factors affecting the health and illness of individuals and populations

  • Very low, 1% to 3% of patients exposed experience one of the previously mentioned
  • Delayed onset from initial use of NSAID
  • Described with use in all types of NSAIDs

The number of people taking NSAIDs is very high, offsetting low rate per user to high rate per population.

Pathophysiology

Pathophysiology is the study of the disturbance of normal mechanical, physical, and biochemical functions that a disease causes, or that which causes the disease

Inhibition of renal prostaglandin synthesis interferes with renal hemodynamics.

PGI2, PGE2 are responsible for:

TXA2 shown to vasoconstrict glomeruli

Clinical features: NSAID-Induced hemodynamic deterioration of Renal Function

  • Especially in the setting of already vasocontricted states such as CHF, nephrotic syndrome, cirrhosis, volume depletion, chronic kidney disease (CKD)
  • 30% of patient with CKD on NSAIDS develop this syndrome
  • Elderly also at increased risk mostly secondary to pharmacokinetics
  • Fully reversible if caught early

Clinical Features: NSAID Associated Tubulointerstitial nephritis

  • Heavy Proteinuria/Nephrotic syndrome – 83%
  • Focal tubulointerstitial infiltrates on biopsy
  • Some + immunofluorescence for IgG, IgA, IgM and C3 in interstitial membranes
  • Non-oliguric course typical
  • Variable delayed onset
  • May take weeks to many months to resolve, after stopping NSAID

Clinical Features: NSAID associated Hypertension

  • Usually only a modest increase in BP – an average increase of 6-8mmHg of MAP in patient on NSAIDs
  • NSAIDs mitigate effects of B-blockers and diuretics
  • CCB less susceptible to effects of NSAIDs
  • Elderly, Blacks, low renin hypertension most susceptible

Clinical Oddballs

  • Minimal change disease/Nephrotic syndrome

Treatment

  • Withdraw NSAIDs
  • Avoid Nephrotoxic meds
  • +/- Steroids with NSAID associated tubulointerstitial nephritis

See also

External links


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