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NSAID nephropathy

Also see analgesic nephropathy (chronic interstitial nephritis) Etiology: - NSAID-induced injury is more likely to occur in patients who are volume-depleted - more likely to occur in patients with hypercalcemia - patients with multiple myeloma are at increased risk Pathology: 1) reduced renal blood flow secondary to intrarenal vasoconstriction 2) reduced glomerular filtration rate 3) pyuria 4) minimal change disease +/- chronic interstitial nephritis [2] 5) papillary necrosis 6) membranous nephropathy 6) nephrotic syndrome 8) hyperkalemia & type IV renal tubular acidosis (RTA) 9) hyponatremia 10) fluid retention a) Na+ retention b) may exacerbate congestive heart failure (CHF) Laboratory: - active urinary sediment - increased serum creatinine [6]

Related

non-steroidal anti-inflammatory agent (NSAID)

General

nephropathy

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 16, American College of Physicians, Philadelphia 2012
  2. NEJM Question of the Week. April 18, 2017 https://knowledgeplus.nejm.org/question-of-week/1142
  3. Warren GV, Korbet SM, Schwartz MM, Lewis EJ. Minimal change glomerulopathy associated with nonsteroidal antiinflammatory drugs. Am J Kidney Dis. 1989 Feb;13(2):127-30. PMID: 2629709
  4. Clive DM, Stoff JS Renal Syndromes Associated with Nonsteroidal Antiinflammatory Drugs. N Engl J Med 1984; 310:563-572. March 1, 1984 PMID: 6363936 http://www.nejm.org/doi/full/10.1056/NEJM198403013100905
  5. Schneider V, Levesque LE, Zhang B, Hutchinson T, Brophy JM. Association of selective and conventional nonsteroidal antiinflammatory drugs with acute renal failure: A population- based, nested case-control analysis. Am J Epidemiol. 2006 Nov 1;164(9):881-9. Epub 2006 Sep 27. PMID: 17005625
  6. NEJM Knowledge+ Nephrology/Urology