Nephrotoxicity in the Elderly Due to Co-Prescription of ACE Inhibitors and NSAIDs

摘要: The report by Dr Adhiyaman and others (October 2001 JRSM, pp. 512-514) of renal failure after co-prescription angiotensin converting enzyme (ACE) inhibitors nonsteroidal anti-inflammatory drugs (NSAIDs), together with findings on function in elderly heart patients1, should invoke even greater vigilance the era following RALES study (which reported survival benefit from spironolactone ACE failure). Already there are reports not only deterioration but also hyperkalaemia complicating inhibitors, spironolactone, NSAIDs3,4. Spironolactone aggravates impairment potassium excretion failure. NSAIDs liable to impair their own right, because they can induce hyporeninaemic hypoaldosteronism, which, turn, impairs excretion5. Selective cyclo-oxygenase-2 (COX-2) seem carry some risk nephrotoxicity, as judged anecdotal acute associated rofecoxib6 celecoxib7, so these may differ little this respect conventional NSAIDs. Perhaps time has come for indiscriminate prescription be used an indicator clinical underperformance.