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Aspirin and Kidney Disease a Love Hate relationship.

By admin

Published: September 2, 2009

Acetylsalicylic acid otherwise known as aspirin was a major advance in the treatment of inflammation when it was first discovered in 1853. The chemical compound had been used for centuires before that however in the form of bark and herbs which were found by early man to be helpful for the relief of pain.

The chemical structure above served for the development of many novel drugs with potent anti inflammatory effects and became one of the most prescribed classes of medication in history collectively known as the non steroidal antiinflammatory drugs or NSAIDs. The sideffects of the Aspirin are shown below in this mindmap by maderoh88

NEGATIVE EFFECTS ON THE KIDNEY.

Aspirin reduces renal blood flow this is not usually a problem in a healthy person however in a patient who already has decreased blood volume such as patients with dehydration or blood loss this could precipitate acute renal failure. Several types of kidney disease unified by the loss of protein in the urine, may produce a relative low volume state. Despite the obvious retention of fluid in the skin of the feet and around the eyes, the blood vessels are depleted and hence the kidney is also starved for fluid. In such a setting aspirin will further cause reduction of renal blood flow and tip the patient over into acute renal failure.

Aspirin is an anti inflammatory agent yet it has been known to cause inflammation of the tissues of the kidney a state called an allergic interstitial nephritis. Patients with this disorder may have a skin reaction after administration of aspirin followed by high blood pressure abnormal kidney function and decreased urination, thankfully it is usually self limited.

Aspirin has also been associated with an abnormality of the kidney known as membranous nephropathy. This condition results in thickening of the filter of the kidney and loss of protein in the urine.

BENEFICIAL USES.

Aspirins effect on glomerular blood flow can be beneficial. It would be helpful to understand glomerular function to understand why.

Aspirin has the effect of reducing the flow of blood through the kidney in the areas responsible for filtration. While this may not sound like a good thing, this effect is similar to the effect of angiotensin converting inhibitors or ACEI which are prescribed for delaying progression of renal disease. This effect of aspirin is particularly useful in patients with high degrees of protein loss in the urine. Reduction of pressure within the kidney will lead to decreased filtration of protein by the kidney. Hence at one time aspirin was one of the major drugs used in the treatment of membranous nephropathy and other causes of nephrotic syndrome. The drug has fallen out of use for this indication however because of the negative effects on kidney function produced by aspirin. Inflammatory conditions of the kidney were also thought to be treatable by aspirin, conditions such as membranoproliferative glomerulonephritis which is a very rare form of inflammation of the kidney. However all recent trials have discounted any protective effect of aspirin in this and similar conditions.

Although an anti inflammatory agent aspirin has no role in the treatment of inflammatory disorders of the kidney. At this time superior antiinflammatory agents with less negative effects on the kidney are available.

Aspirin News From Other Websites

[CaRP] Plugin “expander.php” not found in CaRP plugins directory
31 Jul 2010 at 12:51am
MedWorm.com provides a medical RSS filtering service. Data from over 6000 medical RSS feeds is collected and output via different categories. This feed contains the latest items on MedWorm Query: Aspirin

Prescribe Aspirin Early in Pregnancy to Cut Preeclampsia Risk: Meta-Analysis

by Medscape Today Headlines
30 Jul 2010 at 3:14pm
A meta-analysis suggests that women at high risk for preeclampsia, mainly those with a history of preeclampsia, should take low-dose aspirin daily, starting at 16 weeks of gestation. Reuters Health Information (Source: Medscape Today Headlines)

Prevention of Preeclampsia and Intrauterine Growth Restriction With Aspirin S…

by Obstetrics and Gynecology
29 Jul 2010 at 6:47pm
CONCLUSION:: Low-dose aspirin initiated in early pregnancy is an efficient method of reducing the incidence of preeclampsia and IUGR.
PMID: 20664402 [PubMed - as supplied by publisher] (Source: Obstetrics and Gynecology)

Systematic review: Helicobacter pylori and upper gastrointestinal bleeding ri…

by Alimentary Pharmacology and Therapeutics
27 Jul 2010 at 10:00pm
Conclusions The current data are not sufficient to allow meta-analyses. The widely held belief that H. pylori is a risk factor for upper gastrointestinal bleeding in regular aspirin users is not supported by the very limited evidence available. (Source: Alimentary Pharmacology and Therapeutics)

Editorial – Associations of aspirin, non-steroidal anti-inflammatory drug and…

by UroToday
26 Jul 2010 at 10:05pm
BERKELEY, CA (UroToday.com) – In the online edition… (Source: UroToday)

Clopidogrel pre-treatment improves outcomes in patients with STEMI who underg…

by NeLM – News
26 Jul 2010 at 10:00pm
Source: Am Heart J
Area: News
Observational data from a US registry suggest that patients with ST-segment elevation myocardial infarction (STEMI) who receive a 600mg loading dose of clopidogrel have better outcomes from percutaneous coronary intervention (PCI).

The authors note that pre-treatment with a loading dose of clopidogrel improves outcomes for elective PCI and in STEMI patients after fibrinolysis; there is, however, limited evidence covering STEMI patients undergoing primary PCI, and the effect of clopidogrel is time-dependent. They therefore used data from a registry of patients admitted for primary treatment with PCI to a tertiary US centre that had patients referred in from a wide surrounding area. Patients are referred to the centre from community hospitals up to 2…

NHS HTA – chemoprevention of colorectal cancer

by NeLM – Disease Focused Reviews
25 Jul 2010 at 10:00pm
Source: Health Technology Assessment
Area: Evidence > Disease Focused Reviews
This review examines the clinical and cost-effectiveness of micronutrient and pharmacological approaches for chemoprophylaxis of colorectal cancer.

Colorectal cancer (CRC) is one of the most common cancers in the UK, and most tumours arise from adenomatous polyps arising from the intestine lining. Various interventions have been proposed to reduce the risk, and the assessment examined non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin and cyclo-oxygenase-2 (COX-2) inhibitors; folic acid; calcium; vitamin D and antioxidants (including vitamin A, vitamin C, vitamin E, selenium and beta-carotene). Chemoprevention was assessed in the general population, in individuals at increased risk of C…

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About Roger:
Dr. Roger Smith is a nephrologist currently employed to the government of Jamaica. He is the Nephrologist in charge of Spanish Town Dialysis Unit. His interests are lupus nephritis and other glomerulopathies. He was previously a lecturer in Nephrology at the University of the West Indies in the Department of Internal Medicine and Coordinator of the Urogenital Module before moving into private and government practice.