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NSAID Nephropathy — SCE Rheumatology MCQ

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HardRheumatoid ArthritisNSAID NephropathySCE Rheumatology

A patient taking ramipril, furosemide and regular naproxen develops vomiting, hypotension and an abrupt creatinine rise. Which medication-related mechanism is most likely?

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Correct answer: B — Haemodynamic AKI from ACE-inhibitor, diuretic and NSAID effects during hypovolaemia

Volume depletion plus efferent arteriolar dilation from an ACE inhibitor and afferent vasoconstriction from an NSAID can sharply reduce glomerular filtration. The implicated medicines should be reviewed and the patient resuscitated and monitored according to AKI severity.

Reference: NICE NG148: acute kidney injury — recommendations (Updated October 2024): https://www.nice.org.uk/guidance/ng148/chapter/Recommendations; BNF: naproxen (Current BNF monograph, accessed 30 July 2026): https://bnf.nice.org.uk/drugs/naproxen/