Nonsteroidal Antiinflammatory Drugs

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These drugs are so called because, like adrenocortical steroids (see below), they reduce inflammation, especially in joints, but also in other tissues. NSAIDs include aspirin (also present in many over-the-counter drugs), acetaminophen (also sold as Tylenol and present in many other combination drugs), celecoxib (sold as Celebrex), ibuprofen (sold under many names, including Advil, Nuprin, and Motrin), and rofecoxib (sold as Vioxx). These are probably the most widely used drugs on the market. NSAIDs are taken for arthritic pain and for headache, among many other indications. Avoiding these pain relievers is out of the question for most people. If you do find yourself in need of a pain reliever, do not take any of these drugs for more than a few days at a time.

Long-term use of any of these drugs is likely to aggravate kidney damage and occasionally to initiate it. If you are taking any of these drugs long term, testing your urine for protein once a month or so is a good idea. If you have protein in your urine, stop the drugs and repeat the test a week or so later. If the protein is still there, tell your doctor.

Two of the most commonly used drugs, aspirin and acetaminophen, have been studied extensively to determine if they adversely affect patients with chronic kidney disease. For example, in a recent study, 918 Swedish patients with newly diagnosed kidney failure and 980 control subjects were asked about their prior consumption of these drugs. The people with kidney disease reported taking both drugs two and a half times more frequently than the controls, suggesting that these drugs may have aggravated kidney disease. Some people (in both groups) reported a lifetime consumption that totaled more than 50 pounds, which sounds unbelievable but is not really extraordinary; taking a few pills every day for several decades adds up. However, the study's authors could not find hard evidence that the drugs had caused kidney disease.

It is interesting to note, however, that there was no association between kidney disease and the use of other analgesics, such as propoxyphene (Darvon), nonsteroidal drugs other than aspirin (such as naproxyn, sold as Aleve, among other brands), codeine, or pyrazolones (generally not available in the United States). The implication is that these other drugs are safer for pain in people with kidney disease, but this inference must be considered preliminary.

The newer so-called Cox-2 inhibitors, Celebrex and Vioxx, may or may not be preferable. Although they have been widely advertised as less likely to cause gastric irritation, this claim is questionable. Whether these drugs have any adverse effect on the progression of renal failure has not yet been established, but since they do not cause acute kidney damage, or at least not often, they may be relatively safe. They do, however, raise blood pressure a little and may increase the likelihood of heart disease slightly (especially Vioxx) when taken long term. It is not advisable to take these drugs chronically either.

A possible alternative for treatment of arthritic or rheumatic pain in patients with chronic kidney disease is salicyl salicylate, sold as Disalcid. This drug may not activate the pathways that lead to kidney damage; however, my experience with this drug is quite limited.

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