Dear Mona,

Because NSAID have been associated with nephrotoxicity,

they should be used cautiously in patients with renal disease.

Ibuprofen not recommended in severe renal dysfunction.

Metabolism of Ibuprofen (http://dmd.aspetjournals.org/content/40/12/2267.full.pdf+html)

Regards

Non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen are hardly ever used in patients with chronic kidney disease (CKD) including those on dialysis.

This is because prostaglandin is required to dilate the arterioles at the blood inlet of the glomeruli to compensate for reduced renal function. NSAIDs block prostaglandins and has the effect of shutting off this blood flow in failing kidneys. NSAIDs have occasionally been used to perform a 'medical nephrectomy' to stop severe glomerular protein leaks, even at the cost of requiring dialysis.

NSAIDs are also a cause of interstitial nephritis, a cause of renal failure. This is an allergic inflammation, localised in the renal tubules, where the NSAID is concentrated.

In dialysis patients with no renal function, NSAIDs are more likely to cause side-effects as they may accumulate, and their toxic effects enanced by the uraemic state. Intestinal bleeding, a likely side-effect of NSAID is more likely in dialysis patients due to uraemic clotting defects.

Thank you Dr. Yasser and Dr. James for your cooperation

Does this help? See what this says about ibuprofen and fenoprofen

http://www.the-hospitalist.org/hospitalist/article/125688/how-manage-pain-patients-renal-insufficiency-or-end-stage-renal-disease