NEPHROTOXICITY OF NSAIDS AND MTX

Drita Yzeiri Havziu, Marija Hiljadnikova-Bajro, Tatjana Kadifkova Panovska, Biljana Gjorgjeska

Abstract

Rheumatoid arthritis (RA) is a chronic disease requring potencial nephrotoxic therapy with nonsteroidal antinflamatory drugs (NSAIDs) and disease modifying antireumatic drugs (DMARDs). The aim of this study is to identify early renal changes by means of specific biomarkers, as the most sensitive parameter. Methodology: 100 patients (80-RAsero+, 20-RAsero-) with chronic rheumatic pain were treated with NSAIDs and 8 to 16 weeks by metotrexat (MTX) in comparison with the control group. The follow up was 3 times during the treatment. Besides conventional markers of renal function (serum/urine creatinin determined by Jaffe methods, ?nzymaticassay for urea in serum and GFR calculated by Cockcroft Gaunt formulas) we used imunoturbodimetric assay for urine a1 Microgloglobulin (a1M) and microalbuminuria, to monitor glomerular and tubular functioning. Any history of kidney disease was exclusion criteria to enter the study. Results: Following 16 weeks’ treatment with combined therapy with NSAIDs and MTX, no changes were found in the serum creatinine and serum urea, compared with the specific biomarker a1 Microgloglobulin (a1M) and microalbuminuria in all patients (R? sero+ and R? sero-) with 99% interval of confidence (CI), and probability of ??0.01 compared with the control group of healthy patients. Conclusion: We found changes on the glomerular and tubular level, despite the normal values of all the assayed conventional markers for renal function, and we confirmed their sensitivity. We can’t confirm the nephrotoxicity, but, if we follow the elevation of the level of the specific biomarkers, we can use them as early signals for nephrotoxicity.

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