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Do Nsaids Cause Kidney Damage

What Are The Symptoms Of Analgesic Nephropathy

Analgesic Nephropathy (AN), Kidney Damage from NSAIDs

These are the most common symptoms of analgesic nephropathy:

  • Fatigue or weakness, feeling unwell
  • Blood in the urine
  • An increase in urination frequency or urgency
  • Pain in the back or flank area
  • A decrease in urine output
  • Nausea, vomiting
  • Widespread swelling
  • Easy bruising or bleeding

Some people have no symptoms. Kidney damage may be picked up by routine blood tests. The symptoms of analgesic nephropathy may look like other medical conditions or problems. Always talk with your healthcare provider for a diagnosis.

Can You Wreck Your Kidneys With Nsaid Pain Relievers

Most people take their kidneys for granteduntil something bad happens. When your kidneys fail, though, your life hangs in the balance. Short of dialysis or a kidney transplant, kidney failure rapidly becomes a life-threatening condition. Thats why we need to treat our kidneys with respect. NSAID pain relievers can damage kidneys and lead to kidney failure.

The 10 Worst Medications For Your Kidneys

Medications that can damage the kidneys are known as nephrotoxic medications. These drugs can cause direct damage to the kidneys. Some of these medications mildly worsen kidney function and others can cause acute kidney injuries. The risk for kidney damage depends on your individual health and other medications you are taking. For people with even mild kidney failure, you might want to talk to your doctor about the pros and cons of these medications.

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Key Dangers Of Nsaids + Other Common Side Effects

While pain medication has its uses, the dangers of NSAIDs are too great to ignore. These dangers of NSAIDs include risks for your heart, gastrointestinal tract and kidneys, among others.

1. Increased Risk of Heart Failure

Doctors have been concerned for some time that NSAIDs might play a role in heart failure since they cause consumers to retain sodium. Now, research just published in the British Medical Journal finds that NSAIDs increase the risk of heart failure by an alarming 19 percent. The risk directly rises with the amount of NSAIDs taken.

This study was based on the analysis of the medical history of millions of patients from four European countries . The participants were all 18 years of age or older and had started NSAID treatment between 2000 and 2010. This large study specifically looked at the risk of hospital admission for heart failure and the use of 27 individual NSAIDs. The researchers found that current use of any NSAID was found to be associated with a 19 percent increase of risk of hospital admission for heart failure.

Overall, the study found that seven traditional NSAIDs and two COX-2 inhibitors in particular led to an increased risk of heart failure.

Five NSAIDs in particular were linked to significant increased risk of heart failure admission:

  • Diclofenac,
  • Naproxen
  • Nimesulide
  • Piroxicam

2. Gastrointestinal Damage, Ulcers and Internal Bleeding

3. Higher Risk of Renal Failure

4. Serious Allergic Reactions

5. Dangers to Children and Teenagers

Tubulointerstitial Nephritis And Nsaids

renal artery stenosis and ace inhibitor

Tubulointerstitial nephritis is an inflammatory process, whether acute or chronic, that develops in the extraglomerular structures of the kidney. One factor with proven acute risk is the use of NSAIDs. In up to 80% of cases, it occurs with nephrotic proteinuria and more frequently in patients using naproxen, phenoprofen, and ibuprofen. The exact mechanism of its occurrence has not been fully elucidated, however, a delayed hypersensitivity reaction and activation of T lymphocytes are suspected. Additionally, the effect of leukotrienes , through activated T lymphocytes, cause minimal lesion disease and nephrotic syndrome for several days after the use of NSAIDs. These drugs also have longterm effects, examples of which are described below.

One of the mechanisms, through which NSAIDs cause kidney damage, is basement membrane injury. Nasrallah et al. evaluated the kidney effects of NSAIDs in diabetic rats. Studies have shown that chronic PG inhibition through the use of NSAIDs is associated with thinning of the glomerular basement membrane, a reduction in the slit pore diameter, a decrease in the density of podocytes, and an increase in the mesangium. Those alterations lead to exacerbation of the patient’s condition and acceleration of disease progression. Ibuprofen induced more severe symptoms than celecoxib, resulting in severe necrotizing pyelonephritis.

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Risk Of Renal Failure

Although renal failure associated with NSAIDs is relatively rare, Delmas suggested they account for up to 16% of cases of drug-induced acute renal failure. The MHRA cited a case-control study that compared 103 cases of idiopathic acute renal failure and 5,000 age- and sex-matched controls. Current users of NSAIDs were around three times more likely to develop acute renal failure than controls a relative risk of 3.2. The risk declined after discontinuing NSAIDs.

During NSAID treatment, the risk increased in patients with a history of heart failure, hypertension or diabetes, and those reporting hospitalisations and consultant visits in the previous year. Concomitant use of NSAIDs with diuretics or calcium channel blockers also increased the risk of acute renal failure.

NSAIDs alleviate pain and fever by reducing prostaglandin production. Specifically, they block the enzyme cyclo-oxygenase, which synthesizes prostaglandins from arachidonic acid, a fatty acid found in cell membranes. Conventional NSAIDs block both types of cyclo-oxygenase isozyme for prostaglandin production. Cox-2 inhibitors block only one isozyme.

Prostaglandins have numerous important roles. For example, apart from activating inflammation, they can induce vasodilatation, which increases renal blood flow. The MHRA says NSAIDs can reduce renal blood flow, which accounts for most of the renal adverse events associated with the drugs. NSAIDs may also directly damage the kidneys.

What Is The Treatment For Analgesic Nephropathy

Your healthcare provider will figure out the best treatment based on:

  • How old you are
  • Your overall health and past health
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference
  • Stopping all pain killers you have been taking, especially OTC medicines
  • Dietary changes
  • Behavioral changes or counseling to help control chronic pain

Treatment aims to prevent any further kidney damage, and treat any existing kidney failure.

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Could Diclofenac Gel Harm Your Kidneys

Q. I am especially sensitive to NSAIDs because of impaired kidney function. My doctor prescribed diclofenac gel for a muscle injury. Am I absorbing enough of this product to be harmful?

A. Nonsteroidal anti-inflammatory drugs like diclofenac, ibuprofen or naproxen can be hard on the kidneys. The official prescribing information for diclofenac warns that long-term administration could cause renal injury.

It is not clear whether you would absorb enough diclofenac from a topical gel to harm your kidneys. This is best determined by frequent monitoring. Ask your doctor to check your kidney function carefully.

What Clinical Trials Are Open

Do Painkillers cause Kidney Damage? What should I take care of?-Dr.Preeti Doshi

Clinical trials that are currently open and are recruiting can be viewed at

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank Jeffrey Fink, MD, MS, Chief, Division of General Internal Medicine, University of Maryland School of Medicine

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People In Pain Are Caught In The Middle:

Natural approaches such as sensible exercise, acupuncture, bromelain from pineapple, turmeric, tart cherry juice, grape juice with pectin or gelatin may offer some people relief without endangering their kidneys or their hearts.

Norma in North Carolina compares turmeric to NSAIDS:

After a rotator cuff injury, I was in lots of pain. The NSAIDs did not help much. I started taking turmeric after a couple of friends recommended it. The improvement was amazing. I ran out and did not take it or a couple of weeks. The pain was back as badly as before. I started taking turmeric again yesterday and the improvement is again amazing!

Karen also found the active ingredient in turmeric helpful:

A word of caution from The Peoples Pharmacy. Some people are allergic to turmeric and its active ingredient curcumin. This can show up as a bad itchy rash. Others get digestive tract upset. Anyone on a blood thinner should not take this supplement. We have heard from readers that warfarin and turmeric may lead to an increased risk of bleeding .

We have provided much more information about the pros and cons of non-drug approaches for arthritis and joint pain in our book, Quick & Handy Home Remedies.

What Are Clinical Trials And Are They Right For You

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

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Pillar Ii: Get Rid Of Gluten Grains And Legumes

I recommend that all of my patients remove gluten from their diets because its so inflammatory. I highly recommend removing all grains and legumes from your diet as well. Instead, enjoy a diet rich in grass-fed meats and wild-caught fish, as well as fresh, organic fruits and vegetables to support your gut and optimal health.

The Quandary: Nsaid Pain Relievers Or

NSAIDs and blood pressure medicines

Occasional use of NSAIDs for a headache, back spasm or other temporary aches and pains is probably not a problem for most people. When it comes to arthritis or other chronic inflammatory conditions, however, people may need to search for safer options. Older people may be especially vulnerable as kidney function often declines with age.

Louise has few options:

I began to show decreased kidney function after years of taking Aleve twice a day to alleviate hip and back pain. I also have arthritic pain in both hands.

Now I use a little Aspercreme on my hands until they get warmed up. It helps a little.

Tart cherry juice at bedtime helps me to sleep more soundly and seems to help my hands a bit. For hip-back my Dr. prescribed Tramadol as much as 3 times a day but I will take only once with a Tylenol which she said will boost effectiveness.

IF ONLY someone would come up with an NSAID that includes something to protect kidney function! Not many options left for those of us wanting to avoid the heavy-hitter pain meds.

Topical NSAIDs may not prevent problems as Errol notes:

I quit NSAIDs several years as my doctor advised because of early stage kidney disease. After a bad knee injury a specialist put me on Voltaren Gel for 9 months. Now I am in stage 4 kidney disease. I had been stable for several years before the daily use of Voltaren Gel.

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Key Points About Analgesic Nephropathy

  • Long term use of pain killers can cause damage to the kidneys. This includes over-the-counter and prescription pills.
  • This condition is most common in people older than 45 years of age, and more prevalent in women over 30.
  • Often there are no symptoms. It may be found on routine blood or urine tests.
  • Symptoms are related to the build-up of toxins and waste products that are normally filtered by the kidneys.
  • Analgesic nephropathy can lead to acute kidney failure, cancer, or atherosclerosis in later stages.

Gastrointestinal Ulcers And Bleeding

NSAIDs can cause ulcers and bleeding in the stomach because they block the Cox-1 enzyme and disrupt the production of prostaglandins, which protect your stomach from mucosal damage.14 These are some of the most common side effects of NSAID use. In fact, approximately 15% of patients who take NSAIDs long-term develop a peptic ulcer, which is a sore in the lining of the stomach, lower esophagus, or small intestine.15 The risk of bleeding ulcers doubles if you take aspirin with other NSAIDs.

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What To Do If You Have Heart Problems Or Kidney Disease

When people have pain, they often take pain medicines called NSAIDs . These include:

  • Advil and Motrin . Ibuprofen is also in other over-the-counter drugs, such as cold medicines.
  • Aleve .
  • Celebrex .

NSAIDs help ease pain and inflammation. But if you have high blood pressure, heart failure, or kidney disease, you should not take an NSAID. And you should not take any drugs that have ibuprofen or another NSAID in them. Heres why:

Be Careful About Using Over

Do Painkillers cause Kidney Damage? What should I take care of? – Dr. Brij Mohan Makkar

If you take OTC or prescription medicines for headaches, pain, fever, or colds, you may be taking a nonsteroidal anti-inflammatory drug . NSAIDs include popular pain relievers and cold medicines that can damage your kidneys if you take them for a long time, or lead to acute kidney injury if you take them when you are dehydrated or your blood pressure is low.

Ibuprofen and naproxen are NSAIDs. NSAIDs are sold under many different brand names, so ask your pharmacist or health care provider if the medicines you take are safe to use.

You also can look for NSAIDs on Drug Facts labels like the one below.

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Data Extraction And Quality/validity Assessment

Data were extracted into a standardised form and checked for accuracy by a second reviewer. When data were reported in strata, the data were extracted as separate subgroups. The following data were extracted for each included study: author, publication year, study design, population , definition of AKI, inclusion criteria, exclusion criteria, medication exposure , period and length of NSAID usage, number of people who were and were not exposed to NSAIDs, as well as crude unadjusted and adjusted associations between NSAID use and outcomes. The quality of the included studies was evaluated in three domains using the validated Newcastle-Ottawa Quality Assessment Scale for cohort and case-control studies , with each item rated as either one star or missing . Disagreements were resolved by discussions with two authors and a third reviewer was involved where required .

Table 1 Quality assessment

Nsaids Are Bad For Your Blood Pressure

NSAIDs can cause high blood pressure. And if you have high blood pressure, they can make it worse. This increases your chances of having a heart attack or a stroke.

NSAIDs can also keep some blood pressure drugs from working right. NSAIDs can interfere with:

  • Diuretics, or water pills, such as Hydrodiuril . Diuretics remove excess water from the blood vessels.
  • ACE inhibitors, such as Prinivil and Zestril . ACE inhibitors are drugs that relax the blood vessels.
  • ARBs such as Cozaar . ARBs are another group of drugs that relax the blood vessels.

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Plan Ahead To Manage Pain Flu Or Other Illness

Almost everyone gets sick once in a while. Your doctor or pharmacist can help you plan ahead to keep your kidneys safe until you get well. Prepare in advance so you know what to do if you have pain or a fever, diarrhea, nausea, or vomiting, which can lead to dehydration.

Before you get sick, ask your health care provider or pharmacist the following questions

  • If I get sick, are there medicines I should not take while Im sick?
  • If I need to stop medicines when Im sick, when can I restart them?
  • What can I take or do to relieve a headache or other pain?
  • What can I take to relieve a fever?
  • If I have diarrhea or am vomiting, do I need to change how or when I take my blood pressure medicine?

Nsaid Pain Relievers And Kidney Function:

NSAIDs and Acute Kidney Injury

Researchers have discovered that NSAIDs are not as benign as many people think. Taking a pain reliever of this sort can put your kidneys and your heart at risk.

Most recently, a large study in BMJ confirmed earlier reports that people who take NSAIDs are at higher risk for heart attacks. This does not come as a great surprise, since other analyses have shown a link between NSAID use and heart attacks, strokes and cardiac arrest .

People who suffer from arthritis often rely on an NSAID to ease their joint pain. Within a week of starting to use this type of medicine, however, biomarkers of subtle kidney damage may start to climb .

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Do Nsaids Cause Kidney Injury

Non-steroidal anti-inflammatory drugs, or NSAIDs, are medications that help to reduce inflammation. They also control pain and fever and are available over the counter and by prescription. Common NSAIDs include ibuprofen , aspirin , and naproxen sodium . These drugs are typically safe if they are used infrequently, but for people with decreased kidney function or chronic kidney disease, they should be avoided.

Are NSAIDs safe to take?NSAIDs are typically safe to use. However, many patients are sensitive to the side effects of these medications, even with normal kidney function. If you have reduced kidney function or have a number of other medical conditions, you may be much more likely to have problems with taking these drugs.

NSAIDs can affect kidneys by several different mechanisms. They can cause high blood pressure and can also interact with some blood pressure drugs in a way that prevents them from working correctly such as diuretics, ACE inhibitors, and ARBs which are a group of drugs that are designed to relax blood vessels. NSAIDs may increase your fluid retention and can lead to decreased blood flow to kidneys. This is because NSAIDs block prostaglandins, which are the natural chemicals that dilate blood vessels and allow oxygen to reach the kidneys to keep them alive and healthy.

As the regional expert in the diagnosis and treatment of kidney disease, Ochsner offers a full range of nephrology services. Learn more here.


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