NSAIDs and Kidney Health: A Review of the Silent Threat to Renal Function
Saif al deen M. Khatlan, Rokan Hazem Hamad, Othman M. Mohammed, Ali Y. Khudhair
Abstract
Nonsteroidal anti-inflammatory medications (NSAIDs) are frequently recommended to treat rheumatologically and inflammatory diseases as well as to relieve pain. Acute kidney injury (AKI), chronic kidney disease (CKD), acute interstitial nephritis, and renal papillary necrosis are among the serious renal hazards that NSAIDs are linked to, despite their effectiveness, particularly in people who already have kidney disease or those using NSAIDs long-term or at high doses. This umbrella review consolidates evidence from multiple meta-analyses and systematic reviews to clarify the nephrotoxic potential of NSAIDs. The review reveals that NSAID use, including both traditional and selective COX-2 inhibitors, is linked to a 50% to 70% increased risk of AKI and CKD. Adverse effects are primarily related to intrarenal vasculature disruption, glomerular damage, and sodium imbalance. Although some NSAIDs offer specific renal protections, overall, the harm often outweighs the benefits. Further research is needed to better understand these risks, especially the molecular mechanisms underlying NSAID-induced kidney damage and to identify at-risk populations. This understanding will aid in balancing the therapeutic benefits of NSAIDs against their potential renal risks, ensuring safer clinical use.