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Why is aspirin bad for the kidneys?

JoanneNH
Posts: 44
Joined: Sep 2013

Actually, I have only one kidney now.  In another post, someone said no aspirin as it is an anticoagulant.  

Will taking aspirin for my heart health cause bleeding from the kidney?

NanoSecond's picture
NanoSecond
Posts: 505
Joined: Oct 2012

This is from WiKi:

NSAIDs are also associated with a relatively high incidence of renal adverse drug reactions (ADRs). The mechanism of these renal ADRs is due to changes in renal haemodynamics (kidney blood flow), ordinarily mediated by prostaglandins, which are affected by NSAIDs. Prostaglandins normally cause vasodilation of the afferent arterioles of the glomeruli. This helps maintain normal glomerular perfusion and glomerular filtration rate (GFR), an indicator of renal function. This is particularly important in renal failure where the kidney is trying to maintain renal perfusion pressure by elevated angiotensin II levels. At these elevated levels, angiotensin II also constricts the afferent arteriole into the glomerulus in addition to the efferent arteriole it normally constricts. Prostaglandins serve to dilate the afferent arteriole; by blocking this prostaglandin-mediated effect, particularly in renal failure, NSAIDs cause unopposed constriction of the afferent arteriole and decreased renal perfusion pressure.

Common ADRs associated with altered renal function include:

These agents may also cause renal impairment, especially in combination with other nephrotoxic agents. Renal failure is especially a risk if the patient is also concomitantly taking an ACE inhibitor (which removes angiotensin II's vasoconstriction of the efferent arteriole) and a diuretic (which drops plasma volume, and thereby RPF)—the so-called "triple whammy" effect.

In rarer instances NSAIDs may also cause more severe renal conditions:

NSAIDs in combination with excessive use of phenacetin and/or paracetamol (acetaminophen) may lead to analgesic nephropathy.

Here is the link the above is from:

http://en.wikipedia.org/wiki/Non-steroidal_anti-inflammatory_drug

And here is another link explaining the issues - although you can only access a small portion of the website without paying:

http://www.uptodate.com/contents/nsaids-acute-kidney-injury-acute-renal-failure

srbelle1
Posts: 123
Joined: Jul 2013

we were told no Advil and Tylenol only in small amounts; would love to understand your post better. Do you think you could put it into friendlier terms?

thanks, Sarah

it makes me furious that my husband has rarely used drugs but for 7 months, used copious amounts of Advil for the hip pain.

NanoSecond's picture
NanoSecond
Posts: 505
Joined: Oct 2012

Hi Sarah.  I apologise for all the "medicalize". Let me try to simplify the issues.

1. NSAIDs are usually used for the treatment of acute or chronic conditions where pain and inflammation are present.

2. The common NSAIDS available over the counter (such as aspirin, ibuprofen, and naproxen) inhibit both cyclooxygenase-1 (COX-1) and cyclooxygenase-2(COX-2). This inhibits the synthesis of various inflammation causing molecules called prostaglandins and thromboxanes.  It is thought that the inhibiting of COX-2 is partly what leads to the anti-inflammatory, analgesic, and antipyretic effects of these NSAIDS, while those which also inhibit COX-1 may also cause gastrointestinal bleeding and ulcers, particularly aspirin. It is for this reason that COX-2 selective inhibitors are usually recommended.

3. Aspirin is the only NSAID able to irreversibly inhibit COX-1. It is also indicated for inhibition of platelet aggregation. Aspirin inhibits platelet aggregation by inhibiting the action of thromboxane A2. Hence it has "blood-thinning" or anti-coagulant effects. This is useful in the management of arterial thrombosis and prevention of adverse cardiovascular events.

4. If a COX-2 inhibitor is taken, a traditional NSAID (prescription or over-the-counter) should not be taken at the same time. In addition, people on daily aspirin therapy (e.g., for reducing cardiovascular risk) must be careful if they also use other NSAIDs, as these may inhibit the cardioprotective effects of aspirin.

5. NSAIDs are also associated with a relatively high incidence of renal adverse drug reactions. The mechanism of these renal ADRs is due to changes in kidney blood flow, which would ordinarily by mediated by prostaglandins, but they are affected by the NSAIDs. The WiKi explanation above is just explaining in detail how this can lead to renal failure.

6. These agents may also cause renal impairment, especially when used in combination with other nephrotoxic agents. Renal failure is especially a risk if a patient is also simultaneously taking both an ACE inhibitor and a diuretic in order to lower their blood pressure.  This is known as the so-called "triple whammy" effect. Unfortunately many of us taking TKI's are fighting blood pressure issues and so may very well be in this "triple whammy" territory without being aware of it.

7.  In rarer instances NSAIDs may also cause even more severe renal conditions as noted above.

The bottom line is that you need to be extremely careful when taking any NSAIDS.  Many doctors outright forbid the use of Ibuprofen, for example.  They may recommend using acetaminophen (paracetamol; Tylenol) instead, since it is metabolized by the liver and does not directly effect the kidney.  However, it is not anti-inflammatory (does not block COX-2) and so it tends not to work as effectively against pain.

I hope this explanation makes a little more sense for you.

srbelle1
Posts: 123
Joined: Jul 2013

thank you for the friendlier explanation; he has been prescribed both a diuretic and metropalol which I believe is a statin. 

Will ask his doctors how long he needs to be on those; I already cut the metrapolol dose since it had lowered his blood pressure to ridiculous levels.

thank you so much; these boards provide so much information.

sarah

JoanneNH
Posts: 44
Joined: Sep 2013

"metroprolol" is actually metoprolol and is a beta blocker blood pressure medicine.   It is not a statin.  A statin is a cholesterol-lowering medication, like Lipitor.  I am on both hydrochlorothiazide (HCTZ)  and metoprolol, though I am seeing a cardiologist tomorrow and am hoping to discontinue the (HCTZ).  For me, the metoprolol is addressing the blood pressure but not my pulse consistently, so I am not sure what is going on there.

Djinnie's picture
Djinnie
Posts: 756
Joined: Apr 2013

My doctor advised me that asprin can effect kidney function, effecting creatinine clearance. If you have to take asprin for your heart though, I am sure your doctor will monitor you more closely. I would think you would have to be on a high dosage to cause actual bleeding. I know they are not normally recommended immediately after operations, because they can slow down the healing process, but your doctor would be the best person to ask!

Djinnie

GSRon's picture
GSRon
Posts: 1134
Joined: Jan 2013

OK, it all depends..  For me, I am now on a daily aspiin regimin..  1 just ONE aspirin per day.  This is because I now happen to have excessive red blood cells... my body is just making too much of them.  Excessive red blood cells can cause, blood clots, heart attack, and strokes.   So for me it is a matter of what risk is worse.. and Kidney failure is less of a risk than heart failure..  Yes I now am getting blood tests twice a week... along with twice weekly phlebotomy.. that means they remove 1/2 liter of my blood.  FYI, my Createnine hovers around 1.6 to 1.8 and my EGFR is low as well... but heck I feel pretty good over all...

Ron

srbelle1
Posts: 123
Joined: Jul 2013

@Ron, what a choice!!!!! as long as we are not at that brink, information about these drugs is so helpful.

my husband was put on metropolol (sp?) because while going through the intense pain of the intestinal blockage, he experienced a-fib. Docs prescribe, prescribe, prescribe but the combination and interactions are not closely reviewed. At least, that has been my experience.

on the flomax, we don't know if it was temporary or not.

i remember my mom and grandmother taking baby aspirin every day as blood thinner. My grandmother developed an ulcer and bled to death after years of it following her stroke.

sarah

BDS's picture
BDS
Posts: 90
Joined: Aug 2012

Just adding this to the discussion. - BDS

 

 

Daily aspirin protects against deadly cancer, studies suggest

 

By Ryan Jaslow / CBS News/ March 21, 2012, 10:09 AM

 

 (CBS News) Many doctors recommend that patients take a daily dose of aspirin to reduce their risk for a future heart attack or stroke. Now three new studies suggest taking the cheap powdery pill every day can also reduce a person's risk for cancer, or prevent the disease from getting worse in patients who already have it.

 

The studies, all led by Professor Peter M. Rothwell, a professor of clinical neurology at the University of Oxford in the U.K. are published in the March 20 issue of The Lancet and The Lancet Oncology.

 

For one of the studies, Rothwell and his colleagues reviewed data from 51 earlier trials that primarily looked at the effect daily aspirin use had on heart attack prevention. After reviewing the data, the researchers found people who took aspirin daily had a 15 percent lower risk of dying from cancer, and the risk reduction climbed to 37 percent for people who took aspirin daily for 5 years or more.

 

Men and women were about 25 percent less likely to develop cancer in the first place if they took aspirin daily for three years or longer.

 

The second study examined whether aspirin would stall the spread of cancer, known as metastasis. Researchers looked at five earlier trials in which people took a daily dose of aspirin and found that aspirin-takers had a 36 percent lower chance of having their cancer spread. Specifically, colon cancer patients had a 74 percent lower risk of having their cancer spread to other organs if they took aspirin daily. Aspirin also was tied to a 46 percent lower risk for colon, lung and prostate cancers and an 18 percent lower risk for bladder and kidney cancer.

 

"These findings provide the first proof in man that aspirin prevents distant cancer metastasis," the authors wrote. "That aspirin prevents metastasis at least partly accounts for the reduced cancer mortality recently reported in trials of aspirin."

 

The third study also looked at if aspirin could impact cancer's spread, but this time researchers reviewed observational case studies, because those results can often be gleaned quickly, rather than waiting 10-20 years for follow-ups from a randomized clinical trial. This study too found a reduced risk for developing colon cancer - about 38 percent lower - and found similar matches in risk for esophageal, stomach and breast cancer.

 

"In terms of prevention, anyone with a family history would be sensible to take aspirin," Rothwell told The New York Times.

 

These new studies are not the only ones to find aspirin's protective benefit against cancer. Previous research should taking aspirin as little as once a month curbed their pancreatic cancer risk, while another study found people genetically predisposed to colon cancer cut their risk through daily aspirin.

 

But aspirin does carry risks for some people, including a greater likelihood of suffering internal bleeding in the stomach and brain for some . People with any bleeding disorders or history of ulcers, asthma, or heart failure face this risk, according to the Mayo Clinic.

 

Do the cancer prevention benefits outweigh the risks?

 

In an accompanying editorial in the same issue of The Lancet, Dr. Andrew T. Chan and Dr. Nancy R. Cook, professors at Harvard Medical School in Boston, said, "Despite a convincing case that the vascular and anticancer benefits of aspirin outweigh the harms of major extracranial bleeding, these analyses do not account for less serious adverse effects on quality of life, such as less severe bleeding."

 

Other experts were equally as cautious.

 

"Any decision about treatment should be made on an individual basis in consultation with your health care professional," Dr. Eric Jacobs, strategic director of pharmacoepidemiology for the American Cancer Society, told WebMD. "Even low-dose aspirin can substantially increase the risk of serious gastrointestinal bleeding."

 

Also, questions remain about what happens if patients stop taking aspirin. A study last summer found that people who take aspirin daily but stop after a period of time are 60 percent more likely to suffer a heart attack within a year, HealthPop reported.

 

The National Institutes of Health has more on aspirin.

 

http://www.cbsnews.com/8301-504763_162-57401495-10391704/daily-aspirin-protects-against-deadly-cancer-studies-suggest/

 

http://www.renalandurologynews.com/aspirin-found-to-protect-against-kidney-cancer/article/239280/

 

GSRon's picture
GSRon
Posts: 1134
Joined: Jan 2013

BDS thanks again.. Good info. Yes we are all different.. Can't treat us all the same. Ron

NanoSecond's picture
NanoSecond
Posts: 505
Joined: Oct 2012

Thanks BDS.  More good information for sure. However, there are a few problems with this.  First of all, in analyzing any study it is vitally important to understand the difference between relative and absolute reduction in risk.

Secondly, it is very deceiving to make a categorical statement such as "this provides the first proof in man that aspirin prevents distant cancer metastases."  Not exactly.  What it does show is an association with lower risk - but that is not "proof".  It would be more "honest" to characterise this study as showing that reducing internal inflammation by use of aspirin may reduce your risk of cancer or metastasis.

Finally, the mechanism of how aspirin is responsible for this is not (yet) understood.  It is most likely because of its anti-inflammatory properties.  Specifically, its ability to block COX-2.  However, there are other substances that can accomplish that as well - without the adverse side effects.  One of them is curcumin (or Turmeric).

The jury is still out on what is the best method to reduce internal inflammation. But yes, taking aspirin is one way to do it.  But at the risk of gastrointestinal bleeding.

GSRon's picture
GSRon
Posts: 1134
Joined: Jan 2013

All good points.. which is why I stated we all have different needs.   In my case my blood is so thick, internal bleeding is not much of a concern.  My blood is so thick it is amazing.. even with a large needle and a vacuum bottle, without added pressure the blood comes out a drop at a time..  Below are Da Nurses, large needle in hand...  :)

 Da Nurses... with a big needle too..!  :)

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