Journal of nephrology
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Journal of nephrology · Sep 2002
Review Comparative StudyDo non-steroidal anti-inflammatory drugs and COX-2 selective inhibitors have different renal effects?
The main mechanism of action of non-steroidal anti-inflammatory drugs (NSAIDs) is the inhibition of cyclooxygenase (COX), the enzyme involved in prostaglandin synthesis. NSAID nephrotoxicity is linked to this, since prostaglandins act not only in response to inflammatory stimuli, but also as modulators of physiological functions. When blood volume is compromised, prostaglandins play a role in the renal circulation including vasodilatation, renin secretion, and sodium and water excretion. ⋯ In the kidney, "constitutive" expression has been demonstrated for both isoforms. COX-2 inhibitor drugs, such as NSAIDs, reduce sodium excretion, and may cause acute renal failure in patients in whom the maintenance of adequate renal perfusion is "prostaglandin-dependent". Therefore, COX-2 inhibitors, like other NSAIDs, must be used cautiously or not at all in patients with predisposing diseases.