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NSAID Precautions CKD — ESENeph MCQ

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ModerateAcute Kidney InjuryNSAID Precautions CKDESENeph

A 48-year-old woman with CKD G3a (eGFR 55 mL/min/1.73m2) from IgA nephropathy requires an NSAID for acute musculoskeletal pain. She is on Ramipril and Dapagliflozin. If a short course of NSAID is deemed essential, what precautions should be taken?

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Correct answer: E — Use the lowest effective dose for the shortest duration; temporarily hold Dapagliflozin; ensure adequate hydration; check renal function within 1 week

If NSAIDs are deemed clinically essential in CKD, NICE and KDIGO recommend: lowest dose for shortest duration, temporary withholding of SGLT2i (reduces compensatory afferent arteriolar dilation), adequate hydration, and early renal function monitoring. The 'triple whammy' risk (NSAID + RASi + diuretic/SGLT2i) should be mitigated by temporarily holding one agent. Topical NSAIDs may be a safer alternative for localised musculoskeletal pain.

Reference: NICE CG182 – CKD; KDIGO 2024 – CKD (Nephrotoxin Stewardship)