{"id":2695,"date":"2021-06-08T05:52:05","date_gmt":"2021-06-08T05:52:05","guid":{"rendered":"https:\/\/www.kauveryhospital.com\/ima-newsletters\/?p=2695"},"modified":"2025-04-11T03:47:30","modified_gmt":"2025-04-11T03:47:30","slug":"severe-renal-failure-in-an-elderly-woman","status":"publish","type":"post","link":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2021\/severe-renal-failure-in-an-elderly-woman\/","title":{"rendered":"Severe renal failure in an elderly woman"},"content":{"rendered":"<p class=\"caps\">[vc_row][vc_column][vc_column_text]<\/p>\n<p style=\"text-align: justify;\">Mrs. NJ, a 65-year-old patient with diabetes and hypertension with IHD was brought to the ER in a drowsy state. She was hemodynamically stable, looked mildly dehydrated, and had no focal neurological deficits. There was no history of fever, convulsions, and head injury, and her investigations revealed that she was in severe renal failure \u2013 urea 290 mg% creatinine was 9 mg%, and her CBC, liver functions were normal. Her kidney size was normal on ultra-sonogram, and there was no gross proteinuria or microscopic hematuria on urine analysis. Her renal functions were normal 2 months before during a routine check-up.<\/p>\n<p style=\"text-align: justify;\">This history and evaluation were suggestive of severe acute renal failure, the reason for which needed evaluation. She was taken on dialysis that improved her consciousness. On questioning, she revealed that she has been taking NSAIDs for body pain for the last one week.<\/p>\n<p>She underwent 3 sessions of dialysis, and her kidney functions recovered.<\/p>\n<h2><strong>NSAIDs and kidneys<\/strong><\/h2>\n<p style=\"text-align: justify;\">NSAIDs are one of the commonly prescribed medications by different medical specialists and are also self-medicated and sold over-the-counter across pharmacies. They are one of the commonest groups of drugs that cause acute kidney injury (AKI). The two mechanisms by which they cause AKI are \u201chemodynamic\u2019 and \u201cacute interstitial nephritis\u201d (AIN).<\/p>\n<h3><strong>Hemodynamic AKI by NSAIDs<\/strong><\/h3>\n<p>Fig 1: Blood flow in a glomerulus<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-2697 size-full\" src=\"https:\/\/www.kauveryhospital.com\/ima-newsletters\/wp-content\/uploads\/2021\/06\/img-1.jpg\" alt=\"\" width=\"399\" height=\"286\" srcset=\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2021\/06\/img-1.jpg 399w, https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2021\/06\/img-1-300x215.jpg 300w\" sizes=\"auto, (max-width: 399px) 100vw, 399px\" \/><\/p>\n<p>Fig 2 \u2013 role of prostaglandins and NSAID-induced afferent arteriolar constriction<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-2698 size-full\" src=\"https:\/\/www.kauveryhospital.com\/ima-newsletters\/wp-content\/uploads\/2021\/06\/img-2.jpg\" alt=\"\" width=\"599\" height=\"299\" srcset=\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2021\/06\/img-2.jpg 599w, https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2021\/06\/img-2-300x150.jpg 300w\" sizes=\"auto, (max-width: 599px) 100vw, 599px\" \/><\/p>\n<p>There could be immediate restoration of kidney function once the drug is withdrawn.<\/p>\n<h3><strong>Acute interstitial nephritis(AIN) and NSAID use<\/strong><\/h3>\n<p style=\"text-align: justify;\">AIN is another renal disease caused by NSAIDs. Unlike hemodynamic injury, stopping the drug will not improve the renal functions. There will be ongoing renal function worsening, and patients would need a renal biopsy that will show acute tubular damage and inflammatory infiltrates in the interstitium. It usually responds to steroids.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-2699 size-full\" src=\"https:\/\/www.kauveryhospital.com\/ima-newsletters\/wp-content\/uploads\/2021\/06\/img-3.jpg\" alt=\"\" width=\"747\" height=\"299\" srcset=\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2021\/06\/img-3.jpg 747w, https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2021\/06\/img-3-300x120.jpg 300w\" sizes=\"auto, (max-width: 747px) 100vw, 747px\" \/><\/p>\n<p style=\"text-align: justify;\">NSAIDs can also cause nephrotic syndrome, hyperkalemia, chronic tubule interstitial damage, and predisposes to urothelial malignancies..<\/p>\n<p style=\"text-align: justify;\">NSAIDs are double-edged weapons. When used for the appropriate indications, they work wonders. Indiscriminate use, especially in elderly, those with deranged renal functions could cause renal dysfunction, and it is important to recognise and manage them by a nephrologist.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-1844 size-thumbnail alignleft\" src=\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2021\/03\/Dr-Balasubramaniam-raju-Nephrology2019-03-30-01-34-01pm1-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><strong>Dr.R.Balasubramaniyam<\/strong><br \/>\nChief Of Nephrology<br \/>\nKauvery Hospital[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text] Mrs. NJ, a 65-year-old patient with diabetes and hypertension with IHD was brought to the ER in a drowsy state. She was hemodynamically stable, looked mildly dehydrated, and had<\/p>\n","protected":false},"author":2,"featured_media":2696,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30],"tags":[],"class_list":["post-2695","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ima-journal-june-2021"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Severe renal failure in an elderly woman<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2021\/severe-renal-failure-in-an-elderly-woman\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Severe renal failure in an elderly woman\" \/>\n<meta property=\"og:description\" content=\"[vc_row][vc_column][vc_column_text] Mrs. NJ, a 65-year-old patient with diabetes and hypertension with IHD was brought to the ER in a drowsy state. 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