Sat27November0445PM 29

Which of the following renal complications most commonly results from the use of non-steroidal anti-inflammatory analgesics?

(Please select 1 option)

Minimal change glomerulonephritis

Haemodynamic renal insufficiency This is the correct answer

Nephrotic syndrome

Renal papillary necrosis

Interstitial nephritis Incorrect answer selected

Explanation

Reversible renal insufficiency (haemodynamic acute renal failure or kidney injury) is the most common complication of NSAID.

Acute renal failure with NSAID therapy is mediated haemodynamically as a result of decreased renal perfusion after inhibition of prostacyclin (PG) synthesis.

The most important PGs in the kidney are PGE2 and PGI2 (prostacyclin). PGE2 is involved in the regulation of sodium reabsorption in the tubule and it acts as a counter-regulatory factor under conditions of increased sodium reabsorption.

Prostacyclin increases potassium secretion mainly by stimulating secretion of renin and activating the renin-angiotensin system, ultimately resulting in increased secretion of aldosterone. In addition, this vasodilatory PG increases renal blood flow and glomerular filtration rate (GFR) under conditions associated with decreased actual or effective circulating volume, resulting in greater tubular flow and secretion of potassium.

The risk factors are similar to those for electrolyte imbalance and also include sepsis, hypovolaemia, shock, systemic lupus erythematosus, hyperreninaemia and hyperaldosteronism.

Leukotrienes increase vascular permeability in the glomerular and peritubular capillaries, leading to proteinuria and interstitial nephritis.

Generalised vasculitis with glomerulonephritis producing acute kidney injury has been rarely reported.

Answer Statistics

1

6%

2

27%

3

14%

4

55%

Times answered: 254