DIFFERENT RENAL EFFECT DURING ANALGESICS USE IN PATIENTS WITH HEADACHE

Drita Yzeiri Havziu, Biljana Gjorgjeska, Anita Arsovska, Sefedin Bilali, Igor Nikolov, Fatmir Mexhiti

Abstract

Migraine is a common headache disorder that causes significant disabilities. COX inhibitors (also referred to as NSAIDs) are frequently used as a treatment option. Nonsteroidal anti-inflammatory drugs (NSAIDs) were the most commonly used analgesics, followed by paracetamol and aspirin, as analgesic therapy that combines individual agents with different mechanisms of action. Theoretically, this approach can lead to different renal adverse effects. The purpose of the study is to compare renal function based on COX inhibition and detect early nephrotoxicity using specific bioindicators. NSAIDs are mediated via inhibition of prostaglandin synthesis by non-specific blocking cyclooxygenase, leading to vasoconstriction and reversible mild renal impairment in hypo-perfusion. Fluid and electrolyte disturbances, acute renal failure, and acute interstitial nephritis also occur predominantly with NSAIDs. Some studies have reported an association between analgesic nephropathy, as one of the most severe analgesic-related adverse renal effects. Long-term abuse of analgesic combinations or other NSAIDs, although only for some of these agents, is controversial. Besides conventional markers of renal function (serum/urine creatinine determined by Jaffe's methods of enzymatic assay for urea in serum), also Jon selective electrodes (ISE) are used for determination of electrolite in serum. Immunoturbidimetry was used to determine urinary albumin, microalbuminuria and also to monitor glomerular functioning. Patients with any history of kidney diseases were excluded from the study. In the treatment of patients with non-selective COX inhibitors (Piroxicam, Ketoprofen, Ibuprofen), related to selective COX2 inhibitors (Nimesulid / Meloxicam) when monitoring specific biomarkers (microalbuminuria), was observed a significant difference of p <0.01 ** in patients treated with non-selective COX inhibitors. Following the levels of specific biomarkers in urine we can recommend constant monitoring of renal functions during usage of different groups of NSAIDs and be careful while using analgesic-anti-inflammatory drugs

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