The Authors Reply

Abstract

We concur with Dr Dal Moro and Dr Crestani1.Dal Moro F. Crestani A. The hidden secret of acute kidney injury: the urologist!.Kidney Int. 2013; 84: 623-624Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar that nonsteroidal anti-inflammatory drugs (NSAIDs) are a cause of acute kidney injury (AKI) in patients with renal colic who are prescribed NSAIDs by their urologists. This is a well-taken point that in the urologists’ community the judicious use of NSAIDs in patients with renal colic should be stressed, and that, NSAIDs should be avoided as much as possible. According to the European Association of Urology Guidelines,2.Türk C. Knoll T. Petrik A. et al.EAU Guidelines on urolithiasis. 2012http://www.uroweb.org/gls/pdf/20_Urolithiasis_LR%20March%2013%202012.pdfGoogle Scholar pain relief is the first therapeutic step in patients with acute stone episodes: NSAIDs are the first choice. At the same time, although symptomatic relief may be better with NSAIDs compared with opioids, the NSAIDs should be given as a temporary measure and extreme caution needs to be exercised. This should be followed especially if the patients are taking other concomitant drugs that can potentiate the nephrotoxicity of the NSAIDs. NSAIDs, in combination with RAAS blockers, diuretics, and other potentially nephrotoxic drugs, and, in some cases, in combination with two NSAIDs, are indeed an important potential cause of AKI, both in adults and children.3.Misurac J.M. Knoderer C.A. Leiser J.D. et al.Nonsteroidal anti-inflammatory drugs are an important cause of acute kidney injury in children.J Pediatr. 2013; 162: 1153-1159Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar, 4.Lapi F. Azoulay L. Yin H. et al.Concurrent use of diuretics, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers with non-steroidal anti-inflammatory drugs and risk of acute kidney injury: nested case-control study.Br Med J. 2013; 346: e8525Crossref PubMed Scopus (275) Google Scholar, 5.Pérez Gutthann S. García Rodríguez L.A. Raiford D.S. et al.Nonsteroidal anti-inflammatory drugs and the risk of hospitalization for acute renal failure.Arch Intern Med. 1996; 156: 2433-2439Crossref PubMed Scopus (155) Google Scholar So as stressed in the recommendations in our paper,6.Li P.K. Burdmann E.A. Mehta R.L. Acute kidney injury: a global health alert.Kidney Int. 2013; 83: 372-376Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar judicious use of nephrotoxic drugs and awareness of potential drug interactions are key steps that doctors, be it family physicians, general physicians, or urologists, should note very seriously and not prescribe nephrotoxic drugs like NSAIDs indiscriminately and without careful monitoring of the patient’s kidney function.