Therapy with Non-Steroidal Anti-Inflammatory Drugs (NSAID) in Cases of Renal Failure

Non-selective and selective cyclooxygenase inhibitors (coxibs) are potent analgesics and antiphlogistics and are successfully used in the treatment of degenerative and inflammatory joint diseases. Prostaglandins act as modulators of physiological functions in the kidney, and therapy with NSAIDs can have an effect on renal physiology. Not only gastrointestinal and cardiovascular risks, but also renal risks in particular must be considered when prescribing NSAIDs. Traditional non-steroidal anti-inflammatory drugs (NSAID) do not differ from coxibs in terms of nephrotoxic effects. However, physicians should analyse the risks and benefits of prescribing inhibitors of prostaglandin synthesis for each individual patient. Especially patients with renal diseases should not be treated with COX-inhibitors, as most renal effects of NSAIDs are dose-related. Therefore an individual risk calculation is necessary before using COX-2-inhibitors (celecoxib, etoricoxib) or NSAIDs (diclofenac, ibuprofen, meloxicam). In cases of severe renal failure, treatment with COX-inhibitors should not be considered.