Effect of Cyclooxygenase-2 Inhibition on Renal Function in Elderly Persons Receiving a Low-Salt Diet

@article{Swan2000EffectOC,
  title={Effect of Cyclooxygenase-2 Inhibition on Renal Function in Elderly Persons Receiving a Low-Salt Diet},
  author={Suzanne K. Swan and David W. Rudy and K C Lasseter and Charles F. Ryan and Konstantin Buechel and Lawrence J. Lambrecht and Morten B. Mario Pinto and S C Dilzer and O Obrda and K J Sundblad and Carol P Gumbs and David L. Ebel and Hui Quan and Patrick J. Larson and Jules I. Schwartz and Thomas A. Musliner and Barry J. Gertz and Dr D. Craig Brater and Shang-long Yao},
  journal={Annals of Internal Medicine},
  year={2000},
  volume={133},
  pages={1-9}
}
The effects of nonsteroidal anti-inflammatory drugs (NSAIDs) are mediated through their ability to inhibit cyclooxygenase (COX)-catalyzed prostaglandin production. Two isoforms of COX, COX-1 and COX-2, have been identified (1-4); traditional NSAIDs inhibit both isoforms (5). Cyclooxygenase-1 is constitutively expressed throughout the body and is thought to play an essential role in normal gastrointestinal and platelet function, whereas COX-2 is induced in the presence of inflammation… 
Renal Effects of COX-2-Selective Inhibitors
TLDR
It seems unlikely that these COX-2 inhibitors (and perhaps their successors) will offer renal safety benefits over nonselective NSAID therapies, and, at this juncture, it is reasonable to assume that all NSAIDs, including COx-2-selective inhibitors, share a similar risk for adverse renal effects.
Anti-inflammatory agents and renal function.
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TLDR
Patients who are at risk for adverse renal events should be monitored with the same caution when receiving coxibs as when receiving treatment with nonselective NSAIDs.
Renal and cardiovascular effects of selective cyclooxygenase-2 inhibitors.
TLDR
Recent experimental studies showed increased renal COX-2 expression in several models of renal injury, such as the remnant kidney, renovascular hypertension, and diabetes, and implicated COx-2 in the progression of renal failure, suggesting that COZ-2 inhibitors may confer a renoprotective effect in diverse renal disorders.
Renal effects of cyclooxygyenase-2-selective inhibitors.
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COX-2 and the Kidney
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TLDR
Caution should be taken when COX-2 inhibitors are prescribed, especially in high-risk patients (including elderly patients and patients with volume depletion).
Cyclooxygenase-2 selective inhibitors and the kidney
TLDR
Accumulating data using recently developed selective COX2 inhibitors suggest that while these agents spare the gastrointestinal tract they have similar renal effects as non-selective NSAIDs, therefore, caution should be taken when prescribing selectiveCOX2 inhibitor to patients, especially to patients with predisposed physiologic stress.
Pharmacology of cyclooxygenase-2 inhibition in the kidney.
TLDR
Animal models may have limited predictive value for patients, particularly those with renal risk factors, and any uncertainty concerning the safety or therapeutic benefit of COX-2-specific drugs in these patient populations will need to be resolved with clinical investigations.
Renal adverse effects of nonsteroidal anti-inflammatory drugs
TLDR
Introduction of COX-2-selective inhibitors has improved the safety profile of the drugs with regard to their most common side effect which occurs at the gastrointestinal level but has not rendered them less cardio-nephrotoxic.
Combined Lipoxygenase/Cyclo-oxygenase Inhibition in the Elderly
TLDR
A new class of anti-inflammatory drugs, the lipoxygenase (LOX)/COX inhibitors, has been developed as a means of simultaneously inhibiting the synthesis of prostaglandins, thromboxanes and leukotrienes, which seems promising.
Cyclooxygenases, the kidney, and hypertension.
TLDR
Increased renal cortical COX-2 expression is seen in experimental models associated with altered renal hemodynamics and progressive renal injury (decreased renal mass, poorly controlled diabetes), and long-term treatment with selective COx-2 inhibitors ameliorates functional and structural renal damage in these conditions.
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TLDR
The data suggest that acute sodium retention by nonsteroidal anti-inflammatory drugs in healthy elderly subjects is mediated by the inhibition of Cox-2, whereas depression of GFR is due to inhibition ofcox-1.
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TLDR
In patients with stable, mild to moderate chronic renal insufficiency and in normal subjects, GFR and RPF were not significantly decreased after acute dosing, whereas urinary PGE2 and fractional excretions of NaCl and free water decreased significantly.
Cyclooxygenase-2 is associated with the macula densa of rat kidney and increases with salt restriction.
TLDR
The intrarenal distribution of COX-2 and its increased expression in response to sodium restriction suggest that in addition to its proposed role in inflammatory and growth responses, this enzyme may play an important role in the regulation of salt, volume, and blood pressure homeostasis.
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TLDR
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TLDR
The acute and long-term effects of nonsteroidal antiinflammatory drugs (NSAIDs) on the excretion of sodium and potassium, blood pressure, and body weight in young and elderly persons without renal insufficiency, and in elderly persons with moderate renal Insufficiency are determined.
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