Renal biopsy of 32 patients who developed renal complications
after treatment with nonsteroidal anti-inflammatory drugs (
NSAIDs) were studied. The treatment with
NSAIDs in these cases was used for many reasons such as:
headaches,
toothaches, dysmenorrea,
osteochondrosis,
polyarthritis and acute
respiratory infections. The renal function of these patients, before the treatment with
NSAIDs was normal. The renal biopsies were studied by light, electron and immunofluorescence microscopy. In 32 cases treated with
NSAIDs renal changes were shown. There types of morphological changes were found: focal
glomerulonephritis with crescents (FGN)(5 cases), acute tubulo-interstitial diseases (ATID)(8 cases) and
lipoid nephrosis with tubulo-
interstitial nephritis (LN)(19 cases). FGN and ATID possibly represent a hypersensitive reaction of predominantly humoral (FGN) or cellular (ATID) mechanisms. These types of reaction are also seen to occur with the use of various drugs (most commonly with
penicillin type
antibiotics). LN on the other hand is rarely, if ever, seen with any drugs but
NSAIDs and therefore seems to be a characteristic change for
NSAIDs and possibly related to the inhibition of renal
prostaglandin synthesis by
NSAIDs.
NSAIDs-associated renal dysfunction is mainly observed in patients of an increased use of
NSAIDs with ineffective circulatory plasma volume (advanced age,
cardiovascular disease,
overweight and
hypovolemia of various causes).