Chapter 7: NSAID-Associated Kidney Injury

Urine Nephrology Now: A Primer for Students in Nephrology

Andrew Bland, MD

Introduction

Nonsteroidal anti-inflammatory drugs represent one of the most well-established causes of drug-induced nephrotoxicity, with robust evidence demonstrating both acute kidney injury and chronic kidney disease progression risks. NSAIDs are among the most commonly prescribed and over-the-counter medications worldwide, with more than 111 million people in the United States taking prescription NSAIDs annually, plus additional millions using over-the-counter formulations.

Clinical Significance

The widespread availability and perceived safety of NSAIDs contrasts sharply with their well-documented potential for serious nephrotoxicity. Meta-analyses consistently demonstrate 73% increased odds of acute kidney injury in community-dwelling populations, with substantially higher risks in vulnerable populations including elderly patients and those with pre-existing chronic kidney disease.

Epidemiology and Risk Assessment

A comprehensive systematic review and meta-analysis of population-based observational studies found that in the general population, the pooled odds ratio of acute kidney injury for current NSAID exposure was 1.73 (95% CI 1.44 to 2.07), with somewhat higher risk observed in older people (OR 2.51, 95% CI 1.52 to 2.68).

Pathophysiologic Mechanisms of NSAID Nephrotoxicity

Cyclooxygenase Inhibition and Renal Hemodynamics

The primary mechanism of NSAID nephrotoxicity involves inhibition of cyclooxygenase enzymes (COX-1 and COX-2), which interferes with arachidonic acid conversion into prostaglandins E2, prostacyclins, and thromboxanes.

Prostaglandin-Mediated Renal Protection

Within the kidneys, prostaglandins act as vasodilators, increasing renal perfusion through vasodilatation that serves as counter-regulation to mechanisms such as the renin-angiotensin-aldosterone system and sympathetic nervous system activation. Renal prostaglandins cause dilatation of the renal afferent arteriole, a mechanism particularly important for maintaining glomerular filtration rate when renal blood flow is reduced.

COX-1 vs COX-2 Functions

  • COX-1: Expressed constitutively in many tissues and maintains baseline physiologic functions, including maintenance of kidney perfusion and function, regulation of platelet aggregation, and protection of gastric mucosa.
  • COX-2: Expression is modified by growth factors, cytokines, and other external signals and is upregulated in response to inflammation. COX-2 is largely responsible for increased prostaglandin production under circumstances requiring augmentation of renal blood flow.

Hemodynamically-Mediated Acute Kidney Injury

NSAID-associated acute kidney injury is predominantly hemodynamically mediated, resulting in reversible reduction in glomerular filtration rate or ischemic tubular injury. Patients at highest risk are those in whom kidney perfusion depends on prostaglandin-induced vasodilation.

High-Risk States for Hemodynamic AKI

  • Heart failure: Reduced cardiac output requiring prostaglandin compensation
  • Liver cirrhosis: Altered hemodynamics and effective circulating volume
  • Nephrotic syndrome: Reduced effective arterial blood volume
  • Volume depletion: Dehydration, bleeding, or diuretic-induced losses
  • Advanced age: Reduced renal reserve and increased prostaglandin dependence

Acute Interstitial Nephritis Mechanisms

The second major mechanism of NSAID-induced acute kidney injury involves acute interstitial nephritis through idiosyncratic immune reactions. It has been suggested that cyclooxygenase inhibition causes preferential conversion of arachidonic acid to leukotrienes, which may then activate helper T cells.

Distinguishing Features of NSAID-Induced AIN

Unlike hemodynamically-mediated injury, acute interstitial nephritis typically occurs independently of dose and duration of exposure, presenting substantial challenges in identifying at-risk individuals prior to clinical manifestations. As a class, NSAIDs confer an approximate 2-fold increase in risk for acute interstitial nephritis, though the absolute risk remains very low.

Risk Factors for NSAID-Induced Renal Dysfunction

The "Triple Whammy" Effect

The term "triple whammy" describes a particularly dangerous drug combination that significantly increases the risk of acute kidney injury. This term was first coined by Merlin C Thomas in 2000 following the observation that patients demonstrated signs of kidney injury following the concurrent use of ACE inhibitors or ARBs, diuretics and NSAIDs.

Triple Whammy Pathophysiology

The pathophysiology involves disruption of all three major mechanisms of renal autoregulation:

  • Diuretics: Reduce plasma volume leading to reduced renal blood flow
  • ACE inhibitors/ARBs: Inhibit efferent renal arteriolar vasoconstriction that lowers glomerular filtration pressure
  • NSAIDs: By inhibition of prostaglandins and bradykinin, produce afferent arteriolar constriction

Clinical Impact: Current use of triple therapy was associated with an increased rate of acute kidney injury (Rate Ratio 1.31, 95% CI 1.12–1.53) compared to double therapy. The greatest risk occurred in the first 30 days of use (Rate Ratio 1.82, 95% CI 1.35-2.46).

Additional High-Risk Populations

Major Risk Factors

  • Pre-existing chronic kidney disease: Reduced renal reserve and greater dependence on prostaglandin-mediated renal hemodynamics
  • Advanced age: Age-related decline in kidney function and increased medication burden
  • Severe hepatic disease: Cirrhosis (particularly with ascites) increases vulnerability to NSAID nephrotoxicity
  • Systemic arterial hypertension: Higher activation of the renin-angiotensin-aldosterone system
  • Volume depletion: Dehydration, acute bleeding, or gastrointestinal losses
  • Multiple myeloma: Particular susceptibility to nephrotoxic medications

Pediatric Considerations

NSAID-related nephrotoxicity represents an important clinical problem in children, where functionally immature kidneys may significantly affect drug disposition. A comprehensive study of 1,015 children with acute kidney injury identified 21 children with clinical, laboratory, and radiographic studies suggesting NSAID-associated acute tubular necrosis.

Pediatric NSAID Safety

Notably, 75% of children for whom data were available received NSAIDs within recommended dosing limits. Patients under 5 years old were more likely to require dialysis, intensive care unit admission, and longer hospitalization stays. This finding led to recommendations that NSAID dosages should be reduced in young children when possible.

Clinical Diagnosis and Evaluation

Hemodynamically-Mediated AKI

Step 1: Assess Clinical Context - Recent NSAID exposure in setting of volume depletion, heart failure, or other high-risk state

Step 2: Laboratory Evaluation - Rising creatinine, concentrated urine (SG > 1.020), elevated BUN/creatinine ratio (>20:1)

Step 3: Urinalysis - Typically bland sediment with hyaline casts, absence of cellular casts

Step 4: Fractional Excretion - FENa <1% suggests prerenal physiology

NSAID-Induced Acute Interstitial Nephritis

Diagnostic Features

Timeline: Typically occurs days to weeks after NSAID initiation, independent of dose

Clinical Presentation: Often non-specific; classic triad of fever, rash, and eosinophilia occurs in <10% of cases

Laboratory Findings:

  • Acute rise in serum creatinine
  • Pyuria (white blood cells in urine)
  • White blood cell casts (when present, highly suggestive)
  • Mild proteinuria (typically <1-2 g/day)
  • Eosinophiluria (low sensitivity but high specificity when present)

Differential Diagnosis

NSAID-induced AIN must be distinguished from:

  • Acute tubular necrosis from other causes
  • Glomerulonephritis (suggested by significant proteinuria, hematuria, RBC casts)
  • Obstructive nephropathy (ruled out by imaging)
  • Other drug-induced interstitial nephritis

Prevention and Risk Mitigation

Patient Selection and Screening

Pre-prescription Assessment

  • Kidney function: Baseline creatinine and eGFR assessment
  • Volume status: Clinical evaluation for dehydration or volume depletion
  • Cardiovascular status: Assessment for heart failure or reduced effective circulating volume
  • Medication review: Identify potential triple whammy combinations
  • Comorbidity assessment: Evaluate for diabetes, hypertension, liver disease

Safe Prescribing Practices

NSAID Prescribing Guidelines

  • Lowest effective dose: Start with minimal dose for symptom control
  • Shortest duration: Limit treatment to necessary period
  • Avoid combinations: Minimize concurrent nephrotoxic medications
  • Monitor closely: Regular assessment of kidney function during therapy
  • Patient education: Instruct regarding signs/symptoms requiring immediate discontinuation

Alternative Approaches

Topical NSAIDs: A Safer Alternative

Topical NSAID formulations have little systemic absorption, with peak concentrations no greater than 1.5% of oral NSAID formulations. Multiple studies demonstrate that systemic exposure of topical diclofenac sodium gel 1% was 5- to 17-fold lower than oral diclofenac, making topical formulations a viable alternative for musculoskeletal pain.

Management of NSAID-Induced Kidney Injury

Immediate Management

Step 1: Immediate NSAID discontinuation

Step 2: Assessment and correction of volume status

Step 3: Review and discontinue other potentially nephrotoxic medications

Step 4: Monitor electrolytes and kidney function closely

Step 5: Consider nephrology consultation for severe cases

Hemodynamically-Mediated AKI Management

Treatment Approach

  • Volume resuscitation: Careful fluid management to restore effective circulating volume
  • Hemodynamic optimization: Treatment of underlying heart failure or cirrhosis
  • Monitoring: Daily weights, intake/output, electrolytes
  • Recovery timeline: Typically reversible within days to weeks with appropriate management

Acute Interstitial Nephritis Management

Corticosteroid Therapy Considerations

For NSAID-induced AIN, corticosteroid therapy may be beneficial, particularly when initiated early. However, the decision to use steroids should be individualized based on:

  • Severity of kidney injury
  • Duration of symptoms before diagnosis
  • Presence of contraindications to steroid therapy
  • Response to NSAID discontinuation alone

Prognosis: At 6 months post-diagnosis, 49% of patients achieve complete recovery, 39% partial recovery, and 12% no recovery. Early intervention improves outcomes.

Long-term Outcomes and Prognosis

Recovery Patterns

The prognosis for NSAID-induced kidney injury depends heavily on the underlying mechanism and the promptness of recognition and treatment. Hemodynamically-mediated AKI typically shows good recovery potential when the precipitating factors are addressed promptly.

Factors Affecting Recovery

  • Duration of exposure: Longer NSAID exposure associated with poorer recovery
  • Baseline kidney function: Pre-existing CKD limits recovery potential
  • Age: Elderly patients may have slower and incomplete recovery
  • Comorbidities: Diabetes, hypertension may impair recovery
  • Time to treatment: Early recognition and intervention improve outcomes

Chronic Kidney Disease Risk

Multiple large-scale studies have demonstrated dose-dependent associations between NSAID use and chronic kidney disease progression. Regular-dose NSAID use may not significantly affect CKD progression risk, but high-dose NSAID use significantly increases the risk (pooled OR = 1.26, 95% CI: 1.06-1.50).

Long-term Monitoring

Patients who experience NSAID-induced kidney injury should be monitored long-term for:

  • Chronic kidney disease development or progression
  • Hypertension development
  • Proteinuria emergence
  • Cardiovascular complications

Annual assessment of kidney function and urinalysis is recommended for at least 1-2 years following significant NSAID-induced AKI.