Nonsteroidal anti-inflammatory drug induced acute kidney injury; A review and case study

Abstract

Introduction: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly therapeutic classes and are responsible for ten percent of medications dispensed annually. Twelve percent of individuals currently report taking a NSAID daily. Renal injury caused by these agents can present in various forms, resulting from either acute or chronic use. Historically approximately five percent of patients initiated on NSAIDs experience a kidney-related adverse event. Drug-induced renal injury accounts for twenty percent of episodes of acute kidney injury (AKI). Patients requiring renal replacement therapy (RRT) have experienced an increased length of stay with associated healthcare costs per incident. The adverse effects of NSAIDs contribute to a significant economic burden, both to the patient and to the healthcare system. Methods: A medical literature review was composed. Results: Numerous risk factors contribute to the development of drug-induced renal injury and disease. Patient specific factors include volume depletion and comorbid conditions. External risk factors such as use of high-risk medications and diagnostic contrast dyes contribute to the increased risk. Implementation of risk mitigation and educational strategies targeting healthcare professionals has the potential to decrease negative clinical and economic outcomes. Conclusion: Healthcare providers’ understanding of the pathophysiology, diagnostic criteria, and risk factors associated with AKI is vital to improve patient outcomes. Proactively screening high risk patients and utilizing appropriate mitigation strategies contributes to limiting the incidence and severity of injury. When the use of NSAIDs cannot be avoided, utilization of lower doses may be a suitable alternative.