NSAID Use in Renal Disease

NSAID Use in Renal Disease

11. If E.T. was currently exhibiting renal dysfunction, what NSAID could be used?

Sulindac (Clinoril) and nabumetone (Relafen) have been reported to cause less renal insufficiency because of the absence of active urinary nephrotoxic metabolites. These two NSAIDs can still decrease renal blood flow in patients at risk and can cause renal dysfunction via hypersensitivity reactions unrelated to their effects on renal blood flow. Although sulindac and nabumetone appear to be preferred over other NSAIDs in patients with renal dysfunction, clinical experience is not as great with these two drugs relative to other NSAIDs.

Possible drug-induced nephrotic syndrome has been reported with indomethacin (Indocin), ibuprofen (Motrin), naproxen (Naprosyn), phenylbutazone (Butazolidin), fenoprofen (Nalfon), sulindac (Clinoril), and tolmetin (Tolectin). In particular, fenoprofen was implicated in 71% of 31 cases.⁷⁹ The prognosis for recovery of renal function is excellent, although some patients require treatment with corticosteroids.⁸⁰ It is unclear whether patients with pre-existing renal dysfunction are at any greater risk of developing further drug-induced abnormalities, but most clinicians consider it a relative contraindication.

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