Kidney injury associated with non-steroid anti-inflammatory drugs

N. Chebotareva, L. Lysenko
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Abstract

The review is devoted to one of the important problems of the clinic of internal diseases - kidney damage associated with painkillers and main non-steroidal anti-inflammatory drugs (NSAIDs). Possible variants of acute and chronic kidney damage when taking NSAIDs are considered. Acute kidney injury is a serious side effect of NSAIDs associated with suppression of the vasodilatory effects of prostaglandins, decompensation of intrarenal hemodynamics, and an acute decrease in glomerular filtration rate levels. A high risk of acute kidney injury when taking NSAIDs is observed in elderly patients with concomitant diseases and polypharmacy, as well as with an initial impairment of renal function. Taking NSAIDs can cause the development of acute interstitial nephritis in combination with podocytopathy, which is manifested by high proteinuria and nephrotic syndrome in younger patients. The mechanisms and clinical manifestations of analgesic nephropathy - chronic kidney damage leading to progressive renal failure are considered separately. The cause of the development of analgesic nephropathy may be the long-term use of combined analgesic drugs, the so-called analgesic mixtures. The erased clinical picture and the mask of chronic pyelonephritis complicate the diagnosis of this disease. Specific for this pathology is renal papillary calcification on computed tomography in combination with a history of long-term analgesic abuse. Withdrawal of anesthetic drugs can slow down the progression of the disease and the development of end-stage chronic kidney disease. The possibility of the development and progression of chronic kidney disease associated with the certain classes of NSAIDs is discussed. An algorithm for treatment of chronic pain syndrome is presented, depending on the degree of risk of kidney damage.
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非甾体抗炎药引起的肾损伤
本文综述了内科疾病临床的一个重要问题——与止痛药和主要非甾体抗炎药(NSAIDs)相关的肾损害。考虑到服用非甾体抗炎药时可能出现的急性和慢性肾损害。急性肾损伤是非甾体抗炎药的严重副作用,与前列腺素血管舒张作用的抑制、肾内血流动力学失代偿和肾小球滤过率水平的急性降低有关。在合并疾病和多药的老年患者以及初始肾功能受损的患者中,服用非甾体抗炎药发生急性肾损伤的风险较高。服用非甾体抗炎药可导致急性间质性肾炎合并足细胞病的发展,表现为高蛋白尿和肾病综合征。镇痛性肾病-慢性肾损害导致进行性肾功能衰竭的机制和临床表现分别考虑。镇痛性肾病发生的原因可能是长期使用联合镇痛药物,即所谓的镇痛合剂。慢性肾盂肾炎的临床表现模糊,使本病的诊断复杂化。这种病理的特异性表现为计算机断层扫描显示肾乳头状钙化,并伴有长期滥用止痛药的病史。停用麻醉药物可以减缓疾病的进展和终末期慢性肾脏疾病的发展。讨论了与某些非甾体抗炎药相关的慢性肾脏疾病的发展和进展的可能性。慢性疼痛综合征的治疗算法提出,根据程度的风险肾脏损害。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Nephrology and Dialysis
Nephrology and Dialysis Medicine-Nephrology
CiteScore
0.60
自引率
0.00%
发文量
14
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