Renal papillary necrosis associated with indomethacin and phenylbutazone treated rheumatoid arthritis

Antioxidant bioactivity of Samsum ant (Pachycondyla sennaarensis) venom protects against CCL₄-induced nephrotoxicity in mice

To assess whether SAV could influence the effects of carbon tetrachloride (CCL4) exposure, mice were treated with SAV in doses of 100, 200, 300 and 400  μg/kg body weight and the effects on oxidative status and kidney function were studied. Serum levels of creatinine, malondialdehyde (MDA), and blood urea, together with renal and hepatic levels of MDA, glutathione (GSH), superoxide dismutase (SOD), and catalase (CAT) were quantified in order to evaluate antioxidant activity. Results showed that the group injected with CCL4 exhibited significantly higher levels of oxidative stress markers, MDA, and significantly lower concentrations of GSH, SOD and catalase. SAV was found to significantly improve these oxidative markers, occasionally, in a dose-dependent manner. Furthermore, treatment with SAV was associated with the same behaviour in respect to kidney functions which had previously been impaired by CCL4. Histopathological examination demonstrated that SAV, in different groups, improved the renal tissue damage induced by CCL4 and histological scores confirmed that significant improvements were obtained after treatment with SAV, particularly with the lowest dose (100  μg/kg body weight). In conclusion, SAV has the potential capability to restore oxidative stability and to improve kidney functions after CCL4 acute injury.

Piroxicam-induced hepatic and renal histopathological changes in mice

Piroxicam is a non-steroidal anti-inflammatory drug widely used in rheumatic diseases. The aim of this study was to investigate Piroxicam-induced histopathological changes in livers and kidneys of male albino mice.

Nephrotoxicity of xenobiotics

Nephrotoxicity can be grouped by the xenobiotics place of action, by the clinical presentation or by the generic toxic effect. The latter can be dose related, indirect, idiosyncratic or allergic. Nephrotoxicity of lithium, demeclocycline, aminoglycosides, cyclosporine, mercuric ion, nonsteroidal anti-inflammatory drugs, methoxyflurane, ethylene glycol, D-penicillamine and methicillin is reviewed in light of all these three viewpoints, but emphasis is on toxic mechanisms.

Chronic renal disease and papillary necrosis associated with the long-term use of nonsteroidal anti-inflammatory drugs as the sole or predominant analgesic

The risk of renal papillary necrosis and renal dysfunction due to the chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) is unknown. In a prospective study of 259 heavy analgesic users seen in a general medical hospital over an 11-year-period beginning in January 1982, 69 new cases of analgesic nephropathy with renal papillary necrosis were confirmed by intravenous urogram (26.6%), ultrasonography (30.4%), and/or computed tomography (43%). Twenty-nine of these patients (42%) had consumed excessive quantities of NSAIDs alone; an additional nine patients (13%) had consumed NSAIDs predominantly in combinations with paracetamol, aspirin, phenacetin, caffeine, and/or traditional herbal medications. Of those patients who consumed NSAIDs alone, 17 had consumed only a single type of NSAID and the remaining 12 had consumed multiple types of NSAIDs. The amount of NSAIDs administered ranged from 1,000 to 26,600 capsules or tablets over a 2- to 25-year period. Renal impairment (serum creatinine, 126 to 778 mumol/L) was noted in 26 of these 38 patients (64.8%). The reasons given for consuming NSAIDs include gouty arthritis (18 patients), osteoarthritis (seven patients), rheumatoid arthritis (six patients), chronic headache (three patients), gouty arthritis plus chronic headache (three patients), and chronic backache (one patient). All patients were prescribed these drugs and were followed medically. The occurrence of analgesic nephropathy was predominantly in males (male to female ratio, 1.9:1). Most of the patients did not have the characteristic psychological profile attributed previously to analgesic abuse nephropathy. Associated addictive habits, such as the use of psychotropic drugs and sleeping tablets, purgative abuse, and alcoholism, were absent.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of nonsteroidal anti-inflammatory drugs on prostaglandins and renal function

In the past 15 years, there has been an explosion in the number of nonsteroidal anti-inflammatory drugs on the market. Along with this explosion have come increasing reports of the physiologic and pathologic changes seen in the kidneys. This report reviews the effects of prostaglandins on the kidney and the physiologic changes that result when prostaglandin synthesis is blocked. The world literature on renal complications of nonsteroidal anti-inflammatory drugs is reviewed and 274 cases of acute renal disease associated with their use are reported. The following cases are described: nephrotic syndrome (34); acute interstitial nephritis (51); acute tubular necrosis (29); papillary necrosis (53); poor perfusion with renal failure (40); acute glomerulitis or vasculitis (13); and unspecified renal failure (102). Fenoprofen appeared to be more nephrotoxic than other nonsteroidal anti-inflammatory drugs and resulted in multiple renal lesions in the same patient.

Pharmacology of nonsteroidal anti-inflammatory drugs. Practical review for clinicians

Aspirin and the newer nonsteroidal anti-inflammatory drugs are the mainstay of basic therapy in rheumatoid arthritis and the other rheumatic diseases. Despite its many years of clinical use, the pharmacologic actions of aspirin are still not fully understood; those of many of the newer nonsteroidals may offer significant advantages in terms of long-term safety. Studies in animals and normal human volunteers, as well as clinical trials, provide useful information about the absorption, metabolism, excretion, efficacy, appropriate dosage, and safety of a given nonsteroidal agent. Because all of the newer agents have been developed using the same basic animal tests of efficacy, they all closely resemble indomethacin. Differences in half-life, however, may be important in determining the relative safety of a nonsteroidal, especially in older patients. Most of the nonsteroidals bind only to albumin, and therefore have a kind of built-in safety mechanism: once the albumin binding sites are saturated, free drug is rapidly excreted by the kidney and drug accumulation is prevented. Despite this fact, the clinician must be concerned about two frequent sorts of problems that may arise from the prostaglandin-inhibiting effects of the nonsteroidals. Gastrointestinal side effects may include minor symptoms; diffuse gastritis; small erosions of the gastric mucosa, visible only by endoscope; and frank ulceration, which may rarely be life-threatening. Animal studies, various tests in normal volunteers, and pre-marketing clinical studies may all shed light on the relative ulcerogenicity of a given nonsteroidal agent. Long-term clinical experience especially helps indicate which agents appear to be more ulcerogenic than average and which appear to be less than average. Renal effects of the nonsteroidals are also related to their inhibition of prostaglandin synthesis. The most serious of these--a characteristic kind of interstitial nephritis, renal papillary necrosis, and hyperkalemia--are fortunately rare, but some classes of patients--the elderly, those with impaired renal function, and those receiving diuretics--are at increased risk. For these patients, any nonsteroidal anti-inflammatory drug should be prescribed with caution and appropriate monitoring of renal function.

[Renal failure caused by non-steroid anti-inflammatory agents]

This review of literature about non steroidal anti-inflammatory drugs renal accidents is an analysis of acute pathology and a study of renal dysfunctions induced by these drugs. Each chapter allows a physiopathologic study. The care of anti-inflammatory drugs utilisation is specified.