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NSAID renal risk — DGM MCQ

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EasyPolypharmacyNSAID renal riskDGM

An 86-year-old man has worsening renal function and ankle swelling after starting treatment for knee pain. He has heart failure and chronic kidney disease stage 3. Creatinine has risen from 120 to 185 micromol/L. Current medicines include ibuprofen, ramipril, furosemide and bisoprolol. Which medication should be reviewed?

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Reveal the answer and explanation

Correct answer: C — Ibuprofen

NSAIDs can worsen renal function and fluid retention, particularly in heart failure and chronic kidney disease. Bisoprolol and furosemide may be indicated for heart failure, paracetamol is safer for pain, and colecalciferol does not explain acute renal decline. NSAIDs are frequent avoidable causes of decompensation in frail older adults.

Reference: STOPP/START criteria v3; NICE NG56; BNF