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      NSAID associated bilateral renal infarctions: a case report

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          Abstract

          Renal infarctions (RIs) are caused by interruptions in the renal arterial blood flow. RIs are generally considered to be rare, however we present the case of a 37 year old woman whose renal infarction was likely due to the vasoconstrictive effects of non-steroidal anti-inflammatory drugs. Although high-dose non-steroidal anti-inflammatory drugs (NSAIDs) are known to cause a decrease in renal perfusion, they have not been accepted as causative agents in renal infarction. Theoretically, patients in prostaglandin dependent states should be more vulnerable to renovascular vasoconstriction and resulting hypoperfusion in the presence of NSAIDs. Given the high prevalence of NSAID use, we suspect that this mechanism of renal injury may be more prevalent than previously thought.

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          Nephrotoxicity of nonsteroidal anti-inflammatory drugs: physiologic foundations and clinical implications.

          Andrew Whelton (1999)
          Although the prevalence of nephrotoxicity in patients treated with nonsteroidal anti-inflammatory drugs (NSAIDs) is relatively low, the extensive use profile of these agents implies that many persons are at risk. At basal states of normal renal function, the role of renal prostaglandin production for maintenance of stable renal hemodynamic function is relatively limited. Nonetheless, in the clinical setting of reduced renal perfusion as seen in various forms of cardio-renal disease, dehydration, and the aging kidney, the adequacy of renal prostaglandin production mediated predominantly by cyclooxygenase-1 (COX-1) and, potentially, by COX-2 enzyme activity becomes of major significance in the activation of compensatory renal hemodynamics. Inhibition of renal prostaglandin production by the use of NSAIDs in these circumstances can potentially lead to the emergence of several distinct syndromes of disturbed renal function. These include fluid and electrolyte disorders, acute renal dysfunction, nephrotic syndrome/ interstitial nephritis, and renal papillary necrosis. In addition, by blunting the homeostatic renal effects of prostaglandins, NSAIDs can adversely influence blood pressure control, particularly during the use of angiotensin-converting enzyme (ACE) inhibitors, diuretics, and beta blockers. This is a matter of considerable public health concern, in that some 12 million US citizens are concurrently treated with NSAIDs and antihypertensive drugs. Finally, the risk of congestive heart failure is significantly increased when NSAIDs are given to patients receiving diuretic therapy who have cardiovascular risk factors. Physiologic factors, clinical presentations, diagnostic modalities, and clinical management strategies appropriate to these NSAID-induced renal syndromes are described.
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            A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity

            Philip G Conaghan (2011)
            Non-steroidal anti-inflammatory drugs (NSAIDs) represent a diverse class of drugs and are among the most commonly used analgesics for arthritic pain worldwide, though long-term use is associated with a spectrum of adverse effects. The introduction of cyclooxygenase-2-selective NSAIDs early in the last decade offered an alternative to traditional NSAIDs with similar efficacy and improved gastrointestinal tolerability; however, emerging concerns about cardiovascular safety resulted in the withdrawal of two agents (rofecoxib and valdecoxib) in the mid-2000s and, subsequently, in an overall reduction in NSAID use. It is now understood that all NSAIDs are associated with some varying degree of gastrointestinal and cardiovascular risk. Guidelines still recommend their use, but little is known of how patients use these agents. While strategies and guidelines aimed at reducing NSAID-associated complications exist, there is a need for evidence-based algorithms combining cardiovascular and gastrointestinal factors that can be used to aid treatment decisions at an individual patient level.
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              Renal syndromes associated with nonsteroidal antiinflammatory drugs.

              D Clive, J S Stoff (1984)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Nephrol Renovasc Dis
                Journal ID (iso-abbrev): Int J Nephrol Renovasc Dis
                Journal ID (publisher-id): IJNRD
                Journal ID (pmc): ijnrd
                Title: International Journal of Nephrology and Renovascular Disease
                Publisher: Dove
                ISSN (Electronic): 1178-7058
                Publication date (Electronic): 01 August 2019
                Publication date Collection: 2019
                Volume: 12
                Pages: 177-181
                Affiliations
                [1 ]Yale School of Medicine, Department of Internal Medicine, Yale University , New Haven, CT, USA
                Author notes
                Correspondence: William G ChangYale School of Medicine, Department of Internal Medicine, Section of Nephrology, Yale University , PO Box 208029, New Haven, CT06520, USATel +1 203 785 7439Fax +1 203 785 3756Email w.chang@ 123456yale.edu
                [*]

                These authors contributed equally to this work

                Article
                Publisher ID: 212010
                DOI: 10.2147/IJNRD.S212010
                PMC ID: 6682756
                SO-VID: 0c253399-790b-4909-8fb0-e657bc41d0e4
                Copyright © © 2019 Jeon et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 12 April 2019
                Date accepted : 04 July 2019
                Page count
                Figures: 3, Tables: 1, References: 12, Pages: 5
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Nephrology
                Keywords: renovascular,acute kidney injury,vasoconstriction,prostaglandins
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: renovascular, acute kidney injury, vasoconstriction, prostaglandins

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