Поражение почек, ассоциированное с нестероидными противовоспалительными препаратами

Abstract

The review is devoted to one of the important problems of the clinic of internal diseases - kidney damage associated with painkillers and main non-steroidal anti-inflammatory drugs (NSAIDs). Possible variants of acute and chronic kidney damage when taking NSAIDs are considered. Acute kidney injury is a serious side effect of NSAIDs associated with suppression of the vasodilatory effects of prostaglandins, decompensation of intrarenal hemodynamics, and an acute decrease in glomerular filtration rate levels. A high risk of acute kidney injury when taking NSAIDs is observed in elderly patients with concomitant diseases and polypharmacy, as well as with an initial impairment of renal function. Taking NSAIDs can cause the development of acute interstitial nephritis in combination with podocytopathy, which is manifested by high proteinuria and nephrotic syndrome in younger patients. The mechanisms and clinical manifestations of analgesic nephropathy - chronic kidney damage leading to progressive renal failure are considered separately. The cause of the development of analgesic nephropathy may be the long-term use of combined analgesic drugs, the so-called analgesic mixtures. The erased clinical picture and the mask of chronic pyelonephritis complicate the diagnosis of this disease. Specific for this pathology is renal papillary calcification on computed tomography in combination with a history of long-term analgesic abuse. Withdrawal of anesthetic drugs can slow down the progression of the disease and the development of end-stage chronic kidney disease. The possibility of the development and progression of chronic kidney disease associated with the certain classes of NSAIDs is discussed. An algorithm for treatment of chronic pain syndrome is presented, depending on the degree of risk of kidney damage.