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Is Naproxen Safe For Kidney Disease

Nsaids And Blood Pressure

Naproxen, Indomethacin, Ibuprofen – NSAIDs Mechanism of Action, Indications, and Side Effects

COX-2-inhibition enhances the pressure effect of angiotensin II . In patients with essential hypertension, even high doses of celecoxib did not cause any alteration of the antihypertensive effect of lisinopril . ACE inhibitors and angiotensin II receptor blockers are efferent renovasodilators and may cause functional, but reversible, renal insufficiency, which may worsen with NSAIDs by inducing afferent renovasoconstriction. Therefore, lowering of the dose of the NSAIDs as much as possible, lowering of salt intake, retitration of the antihypertensive and calcium channel blockers have been recommended when treating hypertension in a patient taking an NSAID. Another strategy is to use a non-NSAID, such as tramadol or aspirin . Interestingly, patients with rheumatoid arthritis or osteoarthritis and cardiorenal risk factors such as hypertension, congestive heart failure, edema, renal impairment, and advanced age were more likely to receive a coxib than other NSAIDs .

Is Tylenol Or Ibuprofen Worse For Your Kidneys

Unlike Ibuprofen and other NSAIDs, the active ingredient in Tylenol does not cause damage to the kidneys. In fact, the National KidneyFoundation recommends acetaminophen as the pain reliever of choice for occasional use in patients who have underlying kidney disease.

Although NSAIDs are more likely to cause kidney issues, Ibuprofen can still be used as long as it is not taken in excess. Unless otherwise directed by your physician, you should be just fine using Ibuprofen for occasional pain relief.

Treatment For Kidney Failure Transplant Or Dialysis

Many people with kidney failure can continue with treatment using medicines and will have good-functioning kidneys for the rest of their lives.

In a few people, kidney disease will progress to the stage where the kidneys stop working and it becomes life threatening. This is called kidney failure or established renal failure .

This rarely happens suddenly, and there will be time to plan the next stage of your condition. The decision whether to have dialysis, a kidney transplant or supportive treatment should be discussed with your healthcare team.

Read more about dialysis and kidney transplants.

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Nsaids And Risk For Chronic Kidney Disease

Analgesic nephropathy is a slowly progressive chronic kidney disease resulting from daily use for many years of preparations containing at least two analgesics in combination with central-acting dependence-inducing substances, such as caffeine, codein, and/or barbiturates. Analgesic nephropathy is characterized by capillary sclerosis, renal cortical atrophy, chronic interstitial nephritis and/or papillary sclerosis/necrosis/calcifications. In a number of patients with analgesic nephropathy, the uroepithelia can develop transitional cell carcinoma. Analgesic nephropathy can be accurately diagnosed or excluded by computed tomography scanning without contrast media . Even if renal papillary necrosis occurs in patients with analgetic nephropathy, traditional NSAIDs including ibuprofen , tolmetin , indomethacin , benoxaprofen , and naproxen , have been also reported to cause renal papillary necrosis.

Gooch et al. determined the association between NSAID use and the progression of CKD in an elderly community-based cohort. A total of 10,184 subjects were followed for a median of 2.75 years. High-dose NSAID users was associated with an increased risk for rapid CKD progression among subjects with a baseline mean GFR between 60 and 89 mL/min/1.73 m² without risk differential between selective and nonselective NSAID users . Taken together, physicians should always prescribe the lowest effective dose of NSAIDs for the shortest possible time .

Nsaids And Acute Kidney Injury

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Prescriber Update 34:1415

Key Messages

  • All NSAIDs have been associated with the development of acute kidney injury.
  • Acute kidney injury is more likely to occur in patients with other risk factors particularly hypovolaemic states.
  • Renal function should be monitored in at risk patients.
  • If acute kidney injury occurs, the NSAID should be stopped.
  • NSAIDs should be avoided in patients who develop or have a history of interstitial nephritis.

All non-steroidal anti-inflammatory drugs have been associated with the development of acute kidney injury.

NSAIDs and Acute Kidney Injury

NSAIDs can cause two different forms of acute kidney injury1.

  • Haemodynamically mediated .
  • Immune mediated .
  • Acute kidney injury represents a continuum of renal injury ranging from clinically asymptomatic changes in renal function to renal failure and death. Acute kidney injury is characterised by a rapid fall in glomerular filtration rate over hours to days.

    Presentation and Diagnosis

    There are no specific signs or symptoms for NSAID induced acute kidney injury. Symptoms of acute kidney injury can be non-specific and may include shortness of breath, fatigue, confusion, nausea, decreased urine output and ankle/leg swelling2.

    Pathogenesis and Risk Factors

    NSAIDs reversibly inhibit the production of renal prostaglandins via their inhibition of COX-1 and COX-2. Maximal inhibition occurs at steady state plasma concentrations .

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    Nsaids May Increase Kidney Risks With High Blood Pressure

    By Lisa Rapaport, Reuters Health

    4 Min Read

    – People with high blood pressure who regularly take common painkillers known as non-steroidal anti-inflammatory drugs may increase their risk of developing chronic kidney disease, a study from Taiwan suggests.

    While some previous research has linked NSAIDs to impaired kidney function, the results have been mixed and often overlooked the effects on people with high blood pressure, or hypertension, which itself carries an elevated risk for kidney damage.

    For the current study, researchers examined data on more than 30,000 people with hypertension and found that those whod been taking NSAIDs for at least three months were 32 percent more likely to have chronic kidney disease than participants who didnt use the pills.

    In addition, participants who typically took NSAIDs more than once a day had a 23 percent greater risk of developing chronic kidney disease than people who didnt use the pills.

    Even if patients used NSAIDs for less than three months, they still had an 18 percent higher risk of developing chronic kidney disease, the study found.

    Our results suggest that NSAID duration plays a role in chronic kidney disease among subjects with hypertension, said senior study author Hui-Ju Tsai, a scientist at the Institute of Population Health Sciences, National Health Research Institutes in Zhunan.

    SOURCE: bit.ly/1CSGNqI Hypertension, online July 13, 2015.

    Heart Failure And Edema

    The Coxib and traditional NSAID Trialists Collaboration meta-analysis of randomized controlled trials demonstrated an approximately two-fold increase in hospitalizations for heart failure in COX-2 selective-treated patients and nonselective NSAID-treated patients compared to placebo-treated patients. In a Danish National Registry study of patients with heart failure, NSAID use increased the risk of MI, hospitalization for heart failure, and death.Additionally, fluid retention and edema have been observed in some patients treated with NSAIDs. Use of Naproxen may blunt the CV effects of several therapeutic agents used to treat these medical conditions .Avoid the use of Naproxen oral suspension in patients with severe heart failure unless the benefits are expected to outweigh the risk of worsening heart failure. If Naproxen oral suspension is used in patients with severe heart failure, monitor patients for signs of worsening heart failure.Each 5 mL of Naproxen oral suspension contains 39 mg of sodium. This should be considered in patients whose overall intake of sodium must be severely restricted.

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    Flu Vaccines For People With Ckd

    • Injectable influenza vaccines are recommended for use in people with CKD and other health conditions. The flu shot has a long, established safety record in people with CKD.
    • The live attenuated influenza vaccine , also known as the nasal spray vaccine, is not recommended for people with some kinds of chronic health conditions because the safety and effectiveness of this vaccine in people with those conditions has not been established. The nasal spray vaccineis not recommended for people with CKD.

    Your doctor or other health care professional can answer any questions you might have about flu vaccine.

    Get pneumococcal vaccines.

    • Pneumococcal pneumonia is an example of a serious flu-related complication that can cause death.
    • People who have CKD should also be up to date with pneumococcal vaccination to protect against pneumococcal disease, such as pneumonia, meningitis, and bloodstream infections.
    • You can get either Pneumococcal conjugate vaccine or Pneumococcal polysaccharide vaccine when you get the flu vaccine.
    • Talk to your doctor to find out which pneumococcal vaccines are recommended for you.

    Talk with your doctor about other vaccines, including the hepatitis B vaccine, you may need if you have CKD.

    Maximum Recommended Daily Dose

    Managing Chronic Kidney Disease: Take charge of your health

    People should only use OTC naproxen for a short-term period of between 35 days for pain and no more than 3 days for fever. If they need ongoing treatment, people should consult their doctor first.

    For children between 212 years old, the maximum daily dose by weight is 20 mg/kg. They should not be taking more than 1,000 mg in 24 hours.

    When OTC medications, children 12 years and older should not take more than 660 mg in 24 hours.

    Studies have not shown any benefit in using daily doses higher than 1,000 mg, but some sources suggest a maximum of

    • blood clots

    People with high blood pressure should only take naproxen cautiously.

    Naproxen can cause sodium retention in the kidneys, which can result in increased blood pressure. A person with high blood pressure should consult their doctor before taking naproxen.

    Gastrointestinal side effects of taking naproxen can be severe. Bleeding in the stomach, the formation of ulcers, and stomach or intestinal blockages can occur when taking naproxen. Most often, older adults are the most vulnerable age group for gastrointestinal side effects.

    People who have a history of ulcers or gastrointestinal bleeding have a 10-fold higher risk for developing a bleed when taking naproxen. For these individuals, even short-term treatment can be risky.

    Naproxen may interact with several prescription and nonprescription drugs. Drinking alcohol and taking naproxen may increase the risk of gastrointestinal side effects.

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    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.

    How Is Ckd Diagnosed

    CKD has 5 stages. Your healthcare provider will use results from the following tests to find the stage of CKD you have:

    • Blood and urine tests show how well your kidneys are working. They may also show the cause of your CKD.
    • Ultrasound, CT scan, or MRI pictures may be used to check your kidneys. You may be given contrast liquid to help your kidneys show up better in the pictures. Tell the healthcare provider if you have ever had an allergic reaction to contrast liquid. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if you have any metal in or on your body.
    • A biopsy is a procedure to take tissue from your kidney. It is done to find the cause of your CKD.

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    How Should This Medicine Be Used

    Prescription naproxen comes as a regular tablet, a delayed-release tablet, an extended-release tablet, and a suspension to take by mouth. The extended-release tablets are usually taken once a day. The tablets, delayed-release tablets, and suspension are usually taken twice a day for arthritis. The tablets and suspension are usually taken every 8 hours for gout, and every 6 to 8 hours as needed for pain. If you are taking naproxen on a regular basis, you should take it at the same time every day.

    Nonprescription naproxen comes as tablet and a gelatin coated tablet to take by mouth. It is usually taken with a full glass of water every 8 to 12 hours as needed. Nonprescription naproxen may be taken with food or milk to prevent nausea.

    Follow the directions on the package or prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take naproxen exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor or written on the package.

    Shake the liquid well before each use to mix the medication evenly. Use the measuring cup provided to measure each dose of the liquid.

    Swallow the delayed-release tablets and extended release tablets whole do not split, chew, or crush them.

    If you are taking naproxen to relieve the symptoms of arthritis, your symptoms may begin to improve within 1 week. It may take 2 weeks or longer for you to feel the full benefit of the medication.

    Medications That Can Harm The Kidneys

    treatment for kidney disease: 2012

    No matter what kind of medicine you take, whether OTC or prescription, it is destined to take a trip through your kidneys. Taking a drug the wrong way or in excessive amounts can damage these vital, bean-shaped organs and lead to serious complications. In the worst-case scenario, it could necessitate a kidney transplant.

    Compared with 30 years ago, patients todayhave a higher incidence of diabetes and cardiovascular disease, take multiple medications, and are exposed to more diagnostic and therapeutic procedures with the potential to harm kidney function, according to Cynthia A. Naughton, PharmD, senior associate dean and associate professor in the department of pharmacy practice at North Dakota State University. All of these factors are associated with an elevated risk of kidney damage.

    An estimated 20% of cases of acute kidney failure are due to medications. The technical term for this scenario is nephrotoxicity, which is growing more common as the aging population grows, along with rates of various diseases.

    The kidneys get rid of waste and extra fluid in the body by filtering the blood to produce urine. They also keep electrolyte levels balanced and make hormones that influence blood pressure, bone strength and the production of red blood cells. When something interferes with the kidneys, they cant do their job, so these functions can slow down or stop altogether.

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    Antibiotics And Kidney Damage

    Certain medications are known for their potential to cause kidney damage, leading to acute kidney injury or even CKD. Acute kidney injury is the deterioration of renal function over hours or days and involves both structural damage and loss of function. Medications are one of the most common causes of AKI.

    Antibiotics are the most common drugs implicated in reports of drug-induced nephrotoxicity. Certain classes of antibiotics are better known for their nephrotoxic potential, and they include:

    • Aminoglycosides eg. Gentamicin, Tobramycin, Streptomycin and Neomycin
    • Beta-Lactams- this group includes penicillins, cephalosporins and carbapenems.
    • Vancomycin
    • Amphotericin B- is actually an anti-fungal not an antibiotic

    The way that antibiotics cause kidney injury varies depending on the antibiotic involved and the consequences vary from mild forms of tubular injury to significant deterioration of kidney function requiring acute renal replacement therapy .

    Here are some of the consequences of nephrotoxic antibiotics:

    • Acute interstitial nephritis- inflammation and swelling in the kidney.
    • Acute tubular necrosis- damage to the kidney tubules largely due to high levels of oxidative stress.
    • Intratubular crystal deposition- some medications are insoluble in urine and form crystal deposits in the tubules causing acute or chronic kidney injury.
    • Tubular cell toxicity- direct toxic effect of drugs on kidney tubular cells.

    Cox In Ureteral Obstruction And Lithium Nephropathy

    The antidiuretic action of vasopressin depends on the exocytic insertion of AQP2 water channels from a store in intracellular vesicles to the apical plasma membrane of collecting duct principal cells, the so-called shuttle mechanism. Indomethacin markedly reduces the expression of AQP2 water channels in the collecting duct but enhances the shuttling of AQP2. The increased shuttling of APQ2 results in diminished urine volume. The altered urinary concentration ability and body water balance associated with the use of NSAIDs may in part be causally related with the alteration of AQP2 . Lithium treatment is one of the major causes of the acquired form of nephrogenic diabetes insipidus , a clinical syndrome in which the kidney is unable to concentrate urine despite normal or elevated concentrations of the antidiuretic hormone arginine vasopressin. In lithium-induced NDI rat models, downregulation of AQP2 has been demonstrated. For the treatment of NDI, NSAIDs or coxibs have been useful . The upregulation of AQP2 and the Na-K-2Cl inhibition underlies the therapeutic mechanisms by which COX-2 inhibitors enhance antidiuresis in patients with NDI .

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    How Can Medication Damage The Kidneys

    Your kidneys function as your bodys filter, ridding the body of toxins and waste while returning nutrients, vitamins, hormones, and other vital substances to the bloodstream. And because the kidneys receive such heavy volumes of your bloodstream, they are susceptible to damage caused by diabetes and high blood pressure. However, inappropriate medication use can also cause kidney damage.

    When you take pain medication, your kidneys filter their active ingredients into your bloodstream so that they can begin working to ease your symptoms. But because medications like Ibuprofen block body chemicals that cause the blood vessels to dilate, this results in reduced blood flow to the kidneys reducing the blood flow helps stop pain from headaches and other afflictions, but it also means less oxygen passing through to keep the kidneys healthy and functioning properly. Some medications also cause excess water retention, which can put considerable strain on the kidneys. For people suffering from medical conditions like chronic kidney disease, NSAIDs can increase the risk of kidney failure.

    Who Should Get An Annual Flu Shot

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    The Centers for Disease Control recommends the following groups receive an annual flu vaccine shot between November and February :

    • All people aged six months and older.

    It is especially important for certain individuals at high risk of flu complications and those who come in contact with people at high risk of complications to receive the flu vaccine. These people at high risk include:

    • Residents of nursing homes and other long-term care facilities.
    • People who have chronic medical conditions such as asthma, heart disease, diabetes, kidney and liver disorders and chronic lung diseases.
    • People with a weakened immune system, for example, people with cancer, HIV/AIDS, or chronic steroid users.
    • Household members and caregivers of patients at risk of complications from the flu.
    • Women who are or will be pregnant during the flu season .
    • Healthcare workers who come into close contact with patients in hospitals, nursing homes, long-term care facilities, and other healthcare facilities.
    • Infants and children ages six months through 18 years who are taking long-term aspirin therapy. This puts these individuals at risk for experiencing Reye syndrome after flu infection.
    • American Indians/Alaska natives.
    • People who have close contact with children under five years of age for example, people who live with children, nannies and providers of daycare services.
    • People who are morbidly obese .

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