It is definitely preferable to avoid NSAID'S in this patient , as there is renal impairment . Paracetamol would be the safe drug to use for pain relief .

Paracetamol

Thanks sir for absolutely important fact

But so severe pain due osteoarthritis not respond to paracetamol and laryica ??

Now what ??

Sulindac said to be renal friendly NSAID and naproxen is the heart friendly!

Thanks sir

for sharing your thoughts. So it's problematic to affereant & efferent arteolar glomerular antihypertensive drug and NSAID prostaglandin effects

Plus increment in cardiac toxicity then after CVA

Please refer to the analgesic ladder. In renal impairment NSAIDs should be best avoided, but can be used in short occasional bursts, if some important event is around, or in the case of gout. However, paracetamol, paracetamol with codeine, tramadol, meptazinol and oral morphine all can be used. Additionally assess the patient for presence of neuropathic pain as well. If severe pain is a issue, it is best left to be managed by an experienced pain physician.

Hey Dr

I m appreciate this response but actually more information and delectable articles is so important

I agree with all your answers, i.e. NSAID´s should be avoided in renal impairment, as it can cause an acute deterioration of renal function. However, if paracetamol does not work and a NSAID is neces-sary, as in acute gouty arthritis, an experienced Nephrologist should be consulted.

Thanks prof.

Appreciate your knowledge and experience as nephrologest

We as Nephrologist may over emphasize the risk of worsening chronic kidney disease with NSAIDs. Two studies, the Physician's Health Study (JAMA) and the Precision trial (NEJM) have reported very low risk. In the latter, the risk was ~1%.

Find URLs below:

https://www.ncbi.nlm.nih.gov/pubmed/11466097?dopt=Abstract

https://www.nejm.org/doi/full/10.1056/NEJMoa1611593#t=article

Dear consultant

Nice to hear from your experience

This new article absolutely agree with you

https://www.mdmag.com/medical-news/celecoxib-remains-safer-with-aspirin-than-other-nsaids