Kidneys: The Innocent Bystanders

When we purchase over-the-counter medicines, there’s often an assumption of their relative safety and harmlessness. After all, most ‘dangerous’ compounds are protected behind a prescription, right? Surely, if the directions on the back of the box or bottle are followed, no long-term health risks are possible, right?

Unfortunately, this is often not the case. Long term use of NSAIDs — a class of common anti-inflammatory drugs including aspirin and ibuprofen — is associated with an increased risk of acute kidney failure.[1] Previously healthy young people have developed kidney problems due to long-term NSAID use while being none the wiser; kidney injury thus represents a generally unknown side-effect of NSAID use. Indeed, this feeds into a much larger idea within the field of healthcare — the role of the kidney as an ‘innocent bystander’. Often, acute and even chronic kidney injury are iatrogenic — an unintended byproduct of treatments for other diseases or conditions. NSAIDs aren’t the only common treatment that can negatively impact kidney health; diuretics are associated with an increased risk of acute kidney injury and even surgical procedures like heart transplants have been linked to acute kidney failure.[2,3] The susceptibility of the kidneys to iatrogenic conditions is often attributed to the high rate of blood flow through them and the resulting increased exposure to potentially nephrotoxic drugs.[4] After all, the kidneys are the blood filtration system meant to remove waste from the body; it makes sense that the drugs that enter the bloodstream and are filtered out may put a strain on the kidneys. Not just treatments, but even diagnostic techniques can have an adverse effect on the kidneys. The iodinated contrast drugs often used in diagnostic imaging have also been linked to acute kidney injury, with few suitable alternatives available.[5]

With all these harmful pitfalls, preserving kidney health may seem like an impossibility when tackling complex conditions and comorbidities. However, awareness is a crucial first step towards improving patient outcomes. The kidneys are often put on the back burner when managing other conditions; physicians may prescribe NSAIDs, diuretics, and similar drugs that harm the kidneys over time while treating other conditions, or order diagnostic imaging that utilizes contrast fluid that puts a strain on the kidneys. On their own, these small actions may not have a significant effect, but it’s critical to be mindful of how treatments and conditions may intersect to cause renal dysfunction. By spreading awareness of the susceptibility of the kidneys to damage in these ways, individuals at higher risk for developing renal issues may be mindful about their use of certain over-the-counter medications and can develop a better toolkit with which to advocate for themselves.

References:

1 Dixit, M., Doan, T., Kirschner, R., & Dixit, N. (2010). Significant Acute Kidney Injury Due to Non-steroidal Anti-inflammatory Drugs: Inpatient Setting. Pharmaceuticals (Basel, Switzerland), 3(4), 1279–1285. https://doi.org/10.3390/ph3041279

2 Ejaz AA, Mohandas R. Are diuretics harmful in the management of acute kidney injury? Curr Opin Nephrol Hypertens. 2014 Mar;23(2):155-60. doi: 10.1097/01.mnh.0000441150.17202.be. PMID: 24389731.

3 F. J. Romeo et al., Acute Kidney Injury After Cardiac Transplantation: Foe or Common Innocent Bystander? Transplantation Proceedings 50, 1489-1495 (2018).

4 Davidman M, Olson P, Kohen J, Leither T, Kjellstrand C. latrogenic Renal Disease. Arch Intern Med. 1991;151(9):1809–1812. doi:10.1001/archinte.1991.00400090095017

5 Andreucci, M., Faga, T., Serra, R., De Sarro, G., & Michael, A. (2017). Update on the renal toxicity of iodinated contrast drugs used in clinical medicine. Drug, healthcare and patient safety, 9, 25–37. https://doi.org/10.2147/DHPS.S122207

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