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Chronic kidney disease NSAID risk — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareChronic kidney disease NSAID riskUSMLE Step 3

A 70-year-old man with osteoarthritis and stage 3 chronic kidney disease has a creatinine increase from 1.4 to 1.9 mg/dL after starting daily ibuprofen. Blood pressure has increased and urinalysis shows no blood or casts. Renal ultrasound is normal. Which of the following is the most likely explanation for this patient's findings?

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Correct answer: D — Afferent arteriolar vasoconstriction from prostaglandin inhibition

NSAIDs inhibit prostaglandin-mediated afferent arteriolar dilation, reducing renal perfusion and GFR, especially in CKD or volume depletion.

Reference: KDIGO CKD and Drug Safety Guidance