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Renal damage induced by the treatment with non-opioid analgesics--theoretical assumption or clinical significance.

Non-opioid analgesics are some of the most widely used therapeutic agents in clinical practice today. The number of patients at risk for adverse events related to the use of these agents is rapidly expanding. While the gastrointestinal toxicity of these medications is well known, it has become increasingly apparent that the kidney is also an important target for untoward clinical events. Evidence of the nephrotoxicity of analgesic preparations is not sufficiently completed and available in our region. Analgesic-related renal injury has been classified based on mechanism of action into "classic" analgesic nephropathy and NSAID-related renal toxicity. From clinical point of view the renal side effects induced by analgesics can be classified into hemodynamic (functional) side effects and idiosyncratic side effects. The common link in both types of side effects seems to be renal ischemia related to prostaglandin synthesis inhibition. Key enzyme in this process is cyclooxygenase occurring in two isoforms: COX-1 and COX-2. Antiinflammatory effect of NSAIDs is mediated by COX-2 inhibition, while the side effects (gastrotoxicity, nephrotoxicity) by inhibition of COX-1. COX-1 was more inhibited by indomethacin and piroxicam and COX-2 by 6-MNA (active metabolite of nabumetone), diclofenac and ibuprofen. Nimesulide and meloxicam selectively block COX-2 and are recommended to patients at risk or treated with diuretics. (Tab. 2, Fig. 2, Ref. 38.)