Why do NSAIDs increase risk of AKI?

NSAIDs are associated with an increased risk of AKI, due to blockade of the COX-2 enzyme preventing prostacyclin synthesis, which causes afferent arteriolar vasoconstriction. Inhibition is maximal when steady state plasma concentrations are reached, usually after three to seven days of treatment.

Is kidney damage from ibuprofen reversible?

Generally, the renal failure with NSAIDs is acute and reversible, though analgesic nephropathy with papillary necrosis and chronic renal failure are reported.

Do you stop aspirin in AKI?

Furthermore, a recent retrospective cohort analysis has demonstrated a decreased risk of AKI for patients with CKD who were taking aspirin prior to cardiac surgery (76). Furthermore, aspirin may protect against endotoxin-induced AKI (77) and has been suggested to improve kidney transplant survival (78).

Which is harder on your kidneys Tylenol or ibuprofen?

Ibuprofen is harder on the kidneys than acetaminophen. Acetaminophen doesn’t have the same effect on the COX pathway as ibuprofen. So kidney damage is much more rare. Kidney issues are typically only reported when a person has taken too much acetaminophen.

Why is metformin stopped in AKI?

Metformin is not nephrotoxic, but 90% is excreted by the kidneys. Thus, it does not cause AKI but metformin will accumulate in AKI. A Cochrane review (62) and nested case control series (63) have demonstrated that lactic acidosis is extremely rare with 3-4 cases for every 100,000 person-years of metformin treatment.

Which drugs should be stopped in AKI?

Clinicians managing patients with AKI therefore frequently stop drugs that lower blood pressure (particularly ACEI and ARBs, which selectively reduce glomerular pressure) and diuretics. ACEIs, ARBs and potassium-sparing diuretics may also be stopped because of hyperkalaemia.

What medications should you avoid with AKI?

These effects are additive and concomitant administration of ACEI/ARB and NSAID/COX-2 inhibitors (including over the counter medications) in patients at risk of AKI should be avoided.

Do you hold statins in AKI?

Although none of these directly address the safety in AKI, they suggest strongly that statins do not need to be stopped if patients develop AKI. Furthermore, as for aspirin, no cases of AKI were noted following administration of simvastatin 20mg daily in the first UK Heart and Renal Protection study (75).

Do you hold furosemide in AKI?

Electrolyte levels (especially potassium) should be monitored regularly when this combination of diuretics is being used. The clearance of furosemide is delayed in patients with AKI; however, torsemide and bumetanide are metabolized in the liver and their half-lives are not prolonged in AKI.