How NSAIDS cause renal failure?

NSAIDS can induce two forms of acute

renal failure:

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1. Haemodynamically mediated

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2. Acute interstitial nephritis

Haemodynamically mediated: Renal

prostaglandins are vasodilators, but do not play a major role in

renal haemodynamics in healthy patients and the basal rate is

relatively low. When there is underlying disease, such as heart

failure, cirrhosis or volume depletion, the levels of hormone: PGs

are increased and they act as vasodilators to ensure adequate renal

flow and GFR. Inhibition of prostaglandin synthesis with an NSAID

in such patients can lead to reversible renal ischemia, a ↓ in GFR

and acute renal failure.

NSAIDs also produce interstitial

nephritis with or without nephrotic syndrome secondary to minimal

change disease. Although this presents as acute renal failure, it

can progress in some cases to chronic renal failure.

NSAIDs increase the risk of

developing heart failure in patients with a history of HTN, DM or

renal failure, particularly in the first month of use.