Department of Medicine "M. Aresu", University of Cagliari, Cagliari, Italy.
Eur Rev Med Pharmacol Sci. 2011 Dec;15(12):1461-72.
NSAIDs are generally considered to be safe and well tolerated, but, even with the advent of selective COX-2 inhibitors, nephrotoxicity remains a concern. An impaired renal perfusion caused by the inhibition of prostaglandin synthesis is claimed like the more frequent cause of an acute renal failure due to NSAIDs, while a chronic interstitial nephritis or an analgesic nephropathy are believed the causes of a chronic renal failure. The real incidence of renal side effects of NSAIDs is still unclear and it differs between the age of the patients and the reports present in the literature. The occurrence of renal side effects following prenatal exposure to NSAIDs seems to be rare considering the large number of pregnant woman treated with indomethacin or other prostaglandin inhibitors. NSAID-related nephrotoxicity remains an important clinical problem in the newborns, in whom the functionally immature kidney may exert a significant effect on the disposition of the drugs. Instead, nephrotoxicity is a rare event in children and the risk is lower than adults. In healthy adult patients the incidence of renal adverse effects is very low, less than 1%. The risk increased with age. The elderly are at higher risk, and it is correlated at the presence of pretreatment renal disease, hypovolemia due to use of diuretics, diabetes, congestive heart failure or alteration of NSAID pharmacokinetics.
非甾体抗炎药通常被认为是安全且耐受良好的，但即使出现了选择性 COX-2 抑制剂，肾毒性仍是一个关注点。由于前列腺素合成的抑制导致的肾灌注受损被认为是 NSAIDs 引起急性肾衰竭的更常见原因，而慢性间质性肾炎或镇痛性肾病则被认为是慢性肾衰竭的原因。非甾体抗炎药的肾副作用的实际发生率仍不清楚，并且在患者年龄和文献中的报告之间存在差异。考虑到大量接受吲哚美辛或其他前列腺素抑制剂治疗的孕妇，产前暴露于 NSAIDs 后发生肾副作用的情况似乎很少见。NSAID 相关性肾毒性在新生儿中仍然是一个重要的临床问题，在新生儿中，功能不成熟的肾脏可能会对药物的处置产生重大影响。相反，肾毒性在儿童中是罕见的事件，风险低于成人。在健康的成年患者中，肾不良反应的发生率非常低，不到 1%。风险随年龄增长而增加。老年人的风险更高，并且与预处理肾脏疾病、利尿剂引起的血容量不足、糖尿病、充血性心力衰竭或 NSAID 药代动力学改变有关。
