How nephrotoxic are NSAIDs?
PGs can vasodilate renal arteries, increase sodium loss, and increase renin release. They have relatively little impact on the renal system in euvolemic patients with normal renal function. However, in renal insufficiency or hypovolemic states, PGs are important in maintaining adequate glomerular flow and pressure. Nephrotoxic effects of NSAIDs include:
- • Vasoconstriction, leading to decreasing glomerular filtration rate (GFR) and increasing creatinine.
- • Increased sodium retention and blood volume (can be important in patients with congestive heart failure, liver disease, or other conditions leading to renal insufficiency).
- • Papillary necrosis.
- • Hyperkalemia.
- • Hyponatremia.
- • Interstitial nephritis (more common with fenoprofen).