Never what? One of the first rules we learn as Chronic Kidney Disease patients is never to take a NSAID, a non-steroidal anti-inflammatory drug. Raise your hand if you remember why. Hello fellow with the beard in the back of the room; what do you say?
Correct! They further damage the kidneys. Can you tell us how? No? Don’t feel bad. Most people can’t, even those suffering from CKD.
What was that? Oh, you want over the counter (non-prescription) names of some NSAIDS? Sure. Here’s a list courtesy of Nsaids-list at http://www.nsaids-list.com/:
- Aspirin (Aspirin is a brand name; the chemical is called acetylsalicylic acid)
- Celecoxib (Celebrex)
- Dexdetoprofen (Keral)
- Diclofenac (Voltaren, Cataflam, Voltaren-XR)
- Diflunisal (Dolobid)
- Etodolac (Lodine, Lodine XL)
- Etoricoxib (Algix)
- Fenoprofen (Fenopron, Nalfron)
- Firocoxib (Equioxx, Previcox)
- Flurbiprofen (Urbifen, Ansaid, Flurwood, Froben)
- Ibuprofen (Advil, Brufen, Motrin, Nurofen, Medipren, Nuprin)
- Indomethacin (Indocin, Indocin SR, Indocin IV)
- Ketoprofen (Actron, Orudis, Oruvail, Ketoflam)
- Ketorolac (Toradol, Sprix, Toradol IV/IM, Toradol IM)
- Licofelone (under development)
- Lornoxicam (Xefo)
- Loxoprofen (Loxonin, Loxomac, Oxeno)
- Lumiracoxib (Prexige)
- Meclofenamic acid (Meclomen)
- Mefenamic acid (Ponstel)
- Meloxicam (Movalis, Melox, Recoxa, Mobic)
- Nabumetone (Relafen)
- Naproxen (Aleve, Anaprox, Midol Extended Relief, Naprosyn, Naprelan)
- Nimesulide (Sulide, Nimalox, Mesulid)
- Oxaporozin (Daypro, Dayrun, Duraprox)
- Parecoxib (Dynastat)
- Piroxicam (Feldene)
- Rofecoxib (Vioxx, Ceoxx, Ceeoxx)
- Salsalate (Mono-Gesic, Salflex, Disalcid, Salsitab)
- Sulindac (Clinoril)
- Tenoxicam (Mobiflex)
- Tolfenamic acid (Clotam Rapid, Tufnil)
- Valdecoxib (Bextra)
Yes, young lady in the third row. This is a bit more detailed a list than you’d expected? Okay, let’s go back to What Is It And How Did I Get It? Early Stage Chronic Kidney Disease for a simple explanation of NSAID. Please turn to page 134. Those of you with digital copies of the book, search the phrase. Everyone have it?
So now we’re back to the original question. How do NSAIDS further damage our kidneys?
But first I want to tell you just how important it is not to take them by sharing an anecdote with you. The first year after my CKD diagnose, my nephrologist spent a great deal of his time trying to convince me that I had caused by own CKD by taking NSAIDS very, very often. He might have been right with another patient, but I was never one to rely on medications.
I would rather have used natural means to relieve myself of pain. I did have arthritis and usually walked off the pain. As for headaches, I would do the darkened room, rub the temples, mute the electronics and – my magic – ask one of my daughters to kiss my forehead routine. (Class! No snickering. It worked for me.)
Yet, overuse of NSAIDS was so common a cause of CKD that this was the only cause my nephrologist could see. A while after this, studies showed that aging kidneys will lose their filtering power at the rate of ½% per year. He switched to this cause, which I could more readily accept.
Yes, yes, I know we were going to discuss how NSAIDS further damage the kidneys today.
By the way, as early as 1984, the National Institutes of Health at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1483278/?page=2 published a journal article from the Canadian Medical Association Journal entitled Adverse effects of NSAIDs on renal function.
Why no, I’m not procrastinating at all. Here’s the answer to today’s question.
I found this explanation at a site that’s new to me (http://www.empowher.com/wellness/content/what-nsaids-do-your-kidneys):
All NSAIDs work by blocking the action of cyclooxygenase (COX). This enzyme performs a key step in the synthesis of prostaglandins [ me here with a definition of this word from the freedictionary.com at http://medical-dictionary.thefreedictionary.com/Prostaglandins - a group of potent hormonelike substances that produce a wide range of body responses such as changing capillary permeability, smooth muscle tone, clumping of platelets, and endocrine and exocrine functions. They are involved in the pain process of inflammation.], which produce many effects in the body. Two of the effects are pain and inflammation for injured tissue. Other effects include protection of the stomach and homeostasis (regulation) of kidney function. The COX enzyme comes in two forms, COX-1 and COX-2. For a while, it was thought that COX-2 produces the pain and inflammation prostaglandins, while COX-1 produces the protective and regulatory prostaglandins.
The underlining is mine. That’s right, NSAIDS interfere with the regulation of the kidney function. How? Another good question from the middle of the room.
According to the National Kidney Foundation at http://www.kidney.org/atoz/content/painMeds_Analgesics.cfm,
“…because they reduce the blood flow to the kidney.”
So now we need to know why blood flow to the kidneys is important for CKD patients.
If you look at a picture of your kidney, you’ll see that blood with wastes in it is brought to the kidneys by the renal artery and clean blood is exited from the kidneys by the renal vein. Your kidneys are already compromised which means they are not doing such a great job of filtering your blood.
Reduce the blood flow and you’re exacerbating the problem you already have… and all you need to do is avoid NSAIDS to avoid this problem. You’re right, class, that’s not exactly true, but it will help you preserve more of your kidney function.
Any questions for me? For each other?
Well then, thank you for being such a willing and involved group of students.
While we all know this isn’t really a classroom and I’m not a doctor, this should answer a great many of the questions I’ve received via email or comments.
I’m also looking for first source research on both chia seeds and Goji Berries for a reader. It seems there’s quite a bit of conflicting information about the safety of these two for CKD patients. Please send along what you have, but first source only (not opinion, but fact).
It’s been my pleasure, folks.
Until next week,
Keep living your life!