Cumulative Risk of Medications and Renal Failure
Medications and renal failure can go hand in hand. This is of course if we are talking about the right medications. There are numerous medications that can cause an acute renal failure situation, but many times in practice, it is due to a cumulative risk. Here’s a case scenario to ponder…
An 88-year-old female is battling osteoarthritis. She also has a past history of urinary incontinence, edema, hypertension. She is currently receiving oxybutynin, valsartan, and a low dose of furosemide.
For her osteoarthritis, she was prescribed celecoxib 200 mg twice daily for two weeks. She had taken it for 7 days and then decided to also start taking over the counter ibuprofen as she didn’t feel a complete response from the celecoxib.
Soon after starting the ibuprofen, she notices worsening edema, confusion, fatigue, and a reduction in her urine output. She goes to the ER to be evaluated. Upon admission to the ER, her creatinine went from her baseline of 0.9 to 2.6 mg/dL. The combination of the diuretic, ARB, and TWO medications with COX inhibition was the likely cause of the acute renal failure. I discuss the risks of NSAIDs further on this podcast. As a patient takes more and more medications that can impact the kidney, we definitely run a greater risk of this happening.
I do not want to understate the importance of patient-specific factors as well as medications in contributing to the situation. With this patient taking oxybutynin, I have found from experience that many elderly patients with urinary frequency/incontinence issues do not like to drink much fluid. This can also put the patient at risk for inadequate perfusion. Age and hypertension are also risk factors for kidney injury.
When assessing medications and renal failure risk, we must pay attention to over-the-counter agents as well as prescription drugs. Diuretics, ACE/ARBs, and NSAIDs are incredibly common medications. NSAIDs are a special type of problem as this requires that our patient is well educated to understand which over-the-counter analgesics that they should or shouldn’t take.
Here’s another post on common drugs that can cause prerenal kidney failure.
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