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NSAIDS can induce two forms of acute renal failure:

1. Haemodynamically mediated

2. Acute interstitial nephritis

Haemodynamically mediated: Renal prostaglandins are vasodilators, but do not play a major role in renal haemodynamics in healthy patients and the basal rate is relatively low. When there is underlying disease, such as heart failure, cirrhosis or volume depletion, the levels of hormone: PGs are increased and they act as vasodilators to ensure adequate renal flow and GFR. Inhibition of prostaglandin synthesis with an NSAID in such patients can lead to reversible renal ischemia, a ↓ in GFR and acute renal failure.

NSAIDs also produce interstitial nephritis with or without nephrotic syndrome secondary to minimal change disease. Although this presents as acute renal failure, it can progress in some cases to chronic renal failure.

NSAIDs increase the risk of developing heart failure in patients with a history of HTN, DM or renal failure, particularly in the first month of use.

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