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Побочные эффекты нестероидных противовоспалительных препаратов
Дядык А.И., Куглер Т.Е. Побочные эффекты нестероидных противовоспалительных препаратов. Consilium Medicum. 2017; 19 (12): 94–99. DOI: 10.26442/2075-1753_19.12.94-99
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Dyadyk A.I., Kugler T.E. Side effects of non-steroidal anti-inflammatory drugs. Consilium Medicum. 2017; 19 (12): 94–99. DOI: 10.26442/2075-1753_19.12.94-99
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Аннотация
Побочные эффекты лекарственных препаратов, в том числе ренальные и кардиоваскулярные, являются актуальной медицинской проблемой во всем мире. Ведущее место в их развитии занимают нестероидные противовоспалительные препараты (НПВП), являющиеся одним из наиболее часто применяемых классов лекарственных средств. Механизм действия НПВП связан с блокадой синтеза вазодилататорных почечных простагландинов вследствие инактивации фермента циклооксигеназы. Это может приводить к развитию вазомоторного острого повреждения почек, острого тубулоинтерстициального нефрита, хронической болезни почек и другим ренальным побочным эффектам. У больных с артериальной гипертензией НПВП могут вести как к значимому повышению артериального давления, так и изменению фармакокинетики применяемых гипотензивных препаратов. В связи с этим следует строго регламентировать назначение НПВП, медицинские работники должны использовать минимально эффективные дозы и продолжительность применения; оценивать наличие факторов риска развития кардиоваскулярных и ренальных осложнений.
Ключевые слова: нестероидные противовоспалительные препараты, почки, скорость клубочковой фильтрации, острое повреждение почек, тубулоинтерстициальный нефрит, хроническая болезнь почек, простагландины, артериальная гипертензия.
Ключевые слова: нестероидные противовоспалительные препараты, почки, скорость клубочковой фильтрации, острое повреждение почек, тубулоинтерстициальный нефрит, хроническая болезнь почек, простагландины, артериальная гипертензия.
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The side effects of drugs, including renal and cardiovascular complications, are a topical medical problem throughout the world. The leading place in their development is occupied by non-steroidal anti-inflammatory drugs (NSAIDs), which are the most frequently prescribed classes of drugs. The mechanism of action of NSAIDs is associated with the block of synthesis of vasodilator renal prostaglandins due to inactivation of the cyclooxygenase enzyme. This can lead to the development of vasomotor nephropathy, acute tubulointerstitial nephritis, chronic kidney disease and other renal side effects. In patients with hypertension, NSAIDs can lead to both a significant increase in blood pressure and a change in the pharmacokinetics of the antihypertensive drugs. Therefore, the appointment of NSAIDs should be strictly regulated, health workers should use minimally effective doses and duration of use; need competencies in cardiovascular and renal risk factors assessment.
Key words: non-steroidal anti-inflammatory drugs, kidney, glomerular filtration rate, acute kidney damage, tubulointerstitial nephritis, chronic kidney disease, prostaglandins, arterial hypertension).
Полный текст
Список литературы
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4. Hörl W et al. Nonsteroidal Anti-Inflammatory Drugs and the Kidney. Pharmaceuticals (Basel) 2010; 3 (7): 2291–321.
5. Zhang X. Non-steroidal anti-inflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease: systematic review and meta-analysis. BMC Nephrol 2017; 18: 256. Published online 2017 Aug 1 DOI: 10.1186/s12882-017-0673-8
6. Rossert J. Drug-induced acute interstitial nephritis. Kidney Int 2001; 60 (2): 804–17. DOI: 10.1046/j.1523-1755.2001.060002804.x
7. Dreischulte T, Morales DR, Bell S, Guthrie B. Combined use of nonsteroidal anti-inflammatory drugs with diuretics and/or renin-angiotensin system inhibitors in the community increases the risk of acute kidney injury. Kidney Int 2015; 88 (2): 396–403. DOI: 10.1038/ki.2015.101. Epub 2015 Apr 15.
8. Смирнов А.В., Добронравов В.А. и рабочая группа членов Ассоциации нефрологов России. Национальные рекомендации «Острое повреждение почек: основные принципы диагностики, профилактики и терапии» (2015). Ч. 1. Почки. 2016; 2 (16): 63–84. / Smirnov A.V., Dobronravov V.A. i rabochaia gruppa chlenov Assotsiatsii nefrologov Rossii. Natsional'nye rekomendatsii “Ostroe povrezhdenie pochek: osnovnye printsipy diagnostiki, profilaktiki i terapii” (2015). Ch. 1. Pochki. 2016; 2 (16): 63–84. [in Russian]
9. Смирнов А.В., Добронравов В.А. и рабочая группа членов Ассоциации нефрологов России. Национальные рекомендации «Острое повреждение почек: основные принципы диагностики, профилактики и терапии» (2015). Часть 2. Почки. 2016; 3 (17): 39–52. / Smirnov A.V., Dobronravov V.A. i rabochaia gruppa chlenov Assotsiatsii nefrologov Rossii. Natsional'nye rekomendatsii “Ostroe povrezhdenie pochek: osnovnye printsipy diagnostiki, profilaktiki i terapii” (2015). Chast' 2. Pochki. 2016; 3 (17): 39–52. [in Russian]
10. Дударева Л.А., Батюшин М.М. Хронический тубулоинтерстициальный нефрит, индуцированный приемом нестероидных противовоспалительных препаратов: эпидемиологические особенности и возможности ранней диагностики. Нефрология. 2013. 17 (5): 22–6. / Dudareva L.A., Batiushin M.M. Khronicheskii tubulointerstitsial'nyi nefrit, indutsirovannyi priemom nesteroidnykh protivovospalitel'nykh preparatov: epidemiologicheskie osobennosti i vozmozhnosti rannei diagnostiki. Nefrologiia. 2013. 17 (5): 22–6. [in Russian]
11. Huerta C, Castellsaque J, Varas-Lorenzo C et al. Nonsteroidal Anti-Inflammatory Drugs and Risk of ARF in the General Population. Am J Kidney Dis 2005; 45: 531–9.
12. Ungprasert P et al. Individual non-steroidal anti-inflammatory drugs and risk of acute kidney injury: A systematic review and meta-analysis of observational studies. Eur J Intern Med 2015. DOI: 10.1016/j.ejim.2015.03.008
13. Чельцов В.В. НПВС-нефропатии. Клин. нефрология. 2011. 5: 17–23. / Chel'tsov V.V. NPVS-nefropatii. Klin. nefrologiia. 2011; 5: 17–23. [in Russian]
14. Schlondorff D. Renal complications of nonsteroidal anti-inflammatory drugs. Kidney Int 1993; 44 (3): 643–53.
15. Crofford LJ. COX-1 and COX-2 tissue expression: implications and predictions. J Rheumatol Suppl 1997; 49: 15–9.
16. Adegboyega PA et al. Immunohistochemical expression of cyclooxygenase-2 in normal kidneys. Appl Immunohistochem Mol Morphol 2004; 12: 71–4.
17. Komhoff M. Cyclooxygenase-2 selective inhibitors impair glomerulogenesis and renal cortical development. Kidney Int 2000; 57: 414–22.
18. Jonson AG. NSAIDs and increased blood pressure. What is clinical significance? Drug Safety 1997; 17: 277–89.
19. Brodsky S, Nadashy T. Acute and chronic tubulointerstitial nephritis. Heptinstall’s Pathology of the Kidney. Ch. 25: 1111–65.
20. Gambaro G, Perazella MA. Adverse renal effects of anti-inflammatory agents: evaluation of selective and nonselective cyclooxygenase inhibitors. J Intern Med 2003; 253 (6): 643–52.
21. Каратеев А.Е., Насонов Е.Л., Яхно Н.Н. и др. Клинические рекомендации «Рациональное применение нестероидных противовоспалительных препаратов (НПВП) в клинической практике». Соврем. ревматология. 2015; 9 (1): 4–23. DOI: 10.14412/1996-7012-2015-1-4-23 / Karateev A.E., Nasonov E.L., Iakhno N.N. i dr. Klinicheskie rekomendatsii “Ratsional'noe primenenie nesteroidnykh protivovospalitel'nykh preparatov (NPVP) v klinicheskoi praktike”. Sovrem. revmatologiia. 2015; 9 (1): 4–23. DOI: 10.14412/1996-7012-2015-1-4-23 [in Russian]
22. Perazella M, Luciano R. Review of sel ect causes of drug-induced AKI. Expert Rev Clin Pharmacol 2015; 8 (4): 367–71. DOI: 10.1586/17512433.2015.1045489
23. Baker R. Acute tubulointerstitial nephritis: overview. Oxford Textbook of Clinical Nephrology (4 ed.). Section 4. Chapter 2016; 83: 669–77.
24. Kelly C, Neilson E. Tubulointerstitial diseases. Brenner and Rector's the Kidney edited by Karl Skorecki et al. Elsevier, 10 edition. Chapter 2016; 36: 1209–30.
25. Krishnan N, Perazella M. Drug-induced acute interstitial nephritis. Kidney Dis 2015; 9: 3–13.
26. Leonard Ch et al. Proton pump inhibitors and traditional nonsteroidal anti-inflammatory drugs and the risk of acute interstitial nephritis and acute kidney injury. Pharmacoepidemiol Drug Saf 2012; 21: 1155–1172.
27. Nast CC. Medication-Induced Interstitial Nephritis in the 21st Century. Adv Chronic Kidney Dis 2017; 24 (2): 72–9.
28. Baker RJ, Pusey CD. The changing profile of acute tubulointerstitial nephritis. Nephrol Dial Transplant 2004; 19: 8–11.
29. Rossert J, Fischer E. Acute interstitial nephritis. In: Johnson RJ, Feehally J, eds. Comprehensive clinical nephrology. St Louis, Mosby, 2000: 62.1–62.9.
30. Perazella M, Markowitz G. Drug-induced acute interstitial nephritis. Nat Rev Nephrol 2010; 6 (8): 461–70.
31. Izzedine H, Guetin V. Drug-induced acute tubulointerstitial nephritis. Oxford Textbook of Clinical Nephrology (4 ed.) Section 4. Chapter 84: 679–86.
32. Neilson EG. Pathogenesis and therapy of interstitial nephritis. Kidney Int 1989; 35: 1257.
33. Chang C, Gershwin ME. Drugs and autoimmunity – a contemporary review and mechanistic approach. J Autoimmun 2010; 34: J266–75.
34. Singh NP, Ganguli A, Prakash A. Drug-induced kidney diseases. J Assoc Physicians India 2003; 51: 970–9.
35. Kasiske BL, Keane WF. Laboratory assesment of renal biopsy. Brenner and Rector's the Kidney edited by Karl Skorecki et al. Elsevier, 10 edition. 2016; p. 1137–74.
36. Walker P. The renal biopsy. Arch Pathol Lab Med 2009; 133: 181–8.
37. Radford MG. Reversible membranous nephropathy associated with the use of nonsteroidal anti-inflammatory drugs. JAMA 1996; 276 (6): 466–9.
38. Warren GV, Korbet SM, Schwartz MM, Lewis EJ. Minimal change glomerulopathy associated with nonsteroidal antiinflammatory drugs. Am J Kidney Dis 1989; 13 (2): 127–30.
39. Mohammed S. Risk factors for occurrence and recurrence of diabetic foot ulcers among Iraqi diabetic patients. Diabet Foot Ankle 2016; 7: 10.3402/dfa.v7. 29605 DOI: 10.3402/dfa.v7.29605
40. Pirani CL et al. Renal toxicity of nonsteroidal anti-inflammatory drugs. Contrib Nephrol 1987; 55: 159–75.
41. Батюшкин М.М. Роль анальгетиков и нестероидных противовоспалительных препаратов в развитии интерстициального поражения почек. Нефрология и диализ. 2008; 8 (3): 239–43. / Batiushkin M.M. Rol' anal'getikov i nesteroidnykh protivovospalitel'nykh preparatov v razvitii interstitsial'nogo porazheniia pochek. Nefrologiia i dializ. 2008; 8 (3): 239–43. [in Russian]
42. Пентюк О.О. Нефротоксичність лікарських засобів: клінічні прояви, патофізіологічні механізми та підходи до лікування. Раціон. фармакотерапія. 2009. 1: 21–7. / Pentiuk O.O. Nefrotoksichnіst' lіkars'kikh zasobіv: klіnіchnі proiavi, patofіzіologіchnі mekhanіzmi ta pіdkhodi do lіkuvannia. Ratsіon. farmakoterapіia. 2009. 1: 21–7. [in Russian]
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48. Nderitu P, Doos L, Jones PW et al. Non-steroidal anti-inflammatory drugs and chronic kidney disease progression: a systematic review. Family Practice 2013; 30: 247–55. DOI: 10.1093/fampra/cms086
49. Kohlhagen J et al. Does regular use of non-steroidal anti-inflammatory drugs increase the risk of renal disease? Nephrology 2002; 7 (1): 5–11. DOI: 10.1046/j.1440-1797.2002.00069.x
50. Agodoa LY, Francis ME, Eggers PW. Association of analgesic use with prevalence of albuminuria and reduced GFR in US adults. Am J Kidney Dis 2008; 51: 573–83.
51. Yaxley J, Litfin T. Non-steroidal anti-inflammatories and the development of analgesic nephropathy: a systematic review. Ren Fail 2016; 38 (9): 1328–34. Epub 2016 Aug 5. DOI: 10.1080/0886022X.2016.1216708
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54. Schwarz A, Krause PH, Kunzendorf U et al. The outcome of acute interstitial nephritis: Risk factors for the transition fr om acute to chronic interstitial nephritis. Clin Nephrol 2000; 54: 179–90.
55. Ingrasciotta Y, Sultana J, Giorgianni F et al. Association of Individual Non-Steroidal Anti- Inflammatory Drugs and Chronic Kidney Disease: A Population-Based Case Control Study. PLoS ONE 2015; 10 (4): e0122899. DOI:10.1371/journal.pone.0122899
56. Armstrong, EP, Malone DC. The impact of nonsteroidal anti-inflammatory drugs on blood pressure, with an emphasis on newer agents. Clin Ther 2003; 25: 1–18.
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45. Gonzales E, Gutierrez E, Galeano C et al. Early steroid treatment improves the recovery of renal function in patients with drug-induced acute interstitial nephritis. Kidney Int 2008; 73 (8): 940–6.
46. Muriithi AK, Leung N, Valeri AM et al. Biopsy-proven acute interstitial nephritis, 1993–2011: a case series. Am J Kidney Dis 2014; 64: 558–66.
47. Clarcson MR et al. Acute iterstitial nephritis clinical features and response to corticosteroid therapy. Nephrol Dial Transplant 2004; 19 (11): 2778–83.
48. Nderitu P, Doos L, Jones PW et al. Non-steroidal anti-inflammatory drugs and chronic kidney disease progression: a systematic review. Family Practice 2013; 30: 247–55. DOI: 10.1093/fampra/cms086
49. Kohlhagen J et al. Does regular use of non-steroidal anti-inflammatory drugs increase the risk of renal disease? Nephrology 2002; 7 (1): 5–11. DOI: 10.1046/j.1440-1797.2002.00069.x
50. Agodoa LY, Francis ME, Eggers PW. Association of analgesic use with prevalence of albuminuria and reduced GFR in US adults. Am J Kidney Dis 2008; 51: 573–83.
51. Yaxley J, Litfin T. Non-steroidal anti-inflammatories and the development of analgesic nephropathy: a systematic review. Ren Fail 2016; 38 (9): 1328–34. Epub 2016 Aug 5. DOI: 10.1080/0886022X.2016.1216708
52. Mukhin N. i dr. Porazhenie pochek, obuslovlennoe zloupotrebleniem neopioidnymi anal'getikami. Vrach. 2006; 3: 34–7. [in Russian]
53. Chang Yu-Kang et al. Increased Risk of End-Stage Renal Disease (ESRD) Requiring Chronic Dialysis is Associated With Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs). Medicine (Baltimore) 2015; 94 (38): e1362. DOI: 10.1097/MD.0000000000001362
54. Schwarz A, Krause PH, Kunzendorf U et al. The outcome of acute interstitial nephritis: Risk factors for the transition fr om acute to chronic interstitial nephritis. Clin Nephrol 2000; 54: 179–90.
55. Ingrasciotta Y, Sultana J, Giorgianni F et al. Association of Individual Non-Steroidal Anti- Inflammatory Drugs and Chronic Kidney Disease: A Population-Based Case Control Study. PLoS ONE 2015; 10 (4): e0122899. DOI:10.1371/journal.pone.0122899
56. Armstrong, EP, Malone DC. The impact of nonsteroidal anti-inflammatory drugs on blood pressure, with an emphasis on newer agents. Clin Ther 2003; 25: 1–18.
Авторы
А.И.Дядык, Т.Е.Куглер*
Донецкий национальный медицинский университет им. Максима Горького. 83003, Донецк, пр. Ильича, д. 16
*kugler2@mail.ru
Донецкий национальный медицинский университет им. Максима Горького. 83003, Донецк, пр. Ильича, д. 16
*kugler2@mail.ru
________________________________________________
A.I.Dyadyk, T.E.Kugler*
M.Gorky Donetsk National Medical University. 83003, Donetsk, pr. Illicha, d. 16
*kugler2@mail.ru
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.