A Review on NSAID-Induced Acute Kidney Injury: Insights into Current Evidence, Risk Factors and Prevention Strategies

Author

Srushti Vataliya, Dr. Harsha Patel, Ms. Manuni Thakkar, Vaidehi Trivedi, Aryan Vasani, Nancy Soni, Vishakha Thakkar


Abstract

 Aim and Objectives: This review examines the relationship between nonsteroidal anti-inflammatory drug (NSAID) exposure and acute kidney injury (AKI), focusing on renal mechanisms, clinical evidence, risk factors, diagnosis, and prevention. Methods: A focused narrative review was prepared using ten selected publications: mechanistic and clinical reviews, a KDIGO guideline, a systematic review with meta-analysis, and observational studies. The selected evidence addressed renal physiology, AKI risk, interacting medicines, and prevention. This was not a systematic database search. Results: NSAID-mediated cyclooxygenase inhibition reduces renal prostaglandin synthesis and may impair afferent arteriolar dilation. A meta-analysis reported increased odds of AKI in the general population (OR 1.73) and in people with chronic kidney disease (CKD; OR 1.63) (Zhang et al., 2017). Among older adults, 30-day AKI occurred in 0.82% of new NSAID users and 0.59% of non-users (OR 1.41) (Nash et al., 2019). The NSAID–diuretic–ACEI/ARB combination is an important avoidable risk (Dreischulte et al., 2015; Lapi et al., 2013). Conclusion: Risk reduction requires identifying vulnerable patients, reviewing concurrent medicines, avoiding unnecessary exposure, using the lowest effective dose for the shortest practical duration, and monitoring renal function and potassium when indicated.


Keywords

Nonsteroidal anti-inflammatory drugs; Acute kidney injury; Nephrotoxicity; Renal prostaglandins; Cyclooxygenase; Risk factors; Prevention



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References


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