Table 1. Main NSAID effects on kidney function.

	Mechanisms	Risk factors	Prevention/Treatment
Water and electrolyte disorders	PGE2 and PG12-induced kidney vasodilatation inhibition; RAAS activation	NSAID use (most common nephrotoxic effects	Discontinue NSAID use
-Sodium retention
-Hyperkalemia
-Hyponatremia
-Metabolic acidosis
-Lower response to diuretics (especially loop diuretics)
Acute kidney injury	Hemodynamic alterations/Kidney perfusion reduction	Liver diseases; Kidney diseases; Heart failure; Dehydration; advanced age	Avoid in high-risk patients (patients with comorbidities); Discontinue NSAID
Acute interstitial nephritis	Hypersensitivity reaction	Prolonged NSAID exposure; some specific NSAIDs (Phenoprofen, Naproxen, Ibuprofen)	Discontinue NSAID use
Chronic kidney disease	Hemodynamic alterations	Chronic use of NSAIDS	Avoid use in high-risk patients (those with comorbidities and advanced age); Discontinue NSAID use
Papillary necrosis	Direct toxicity	Phenacetine abuse; Aspirin and acetaminophen combination	Discontinue NSAID use and avoid chronic use of analgesics

*PGE2: prostaglandins; PGI2: prostacyclins; RAAS: Renin-angiotensin-aldosterone system; NSAIDs: Non-steroidal anti-inflammatory drugs. Adapted from: Melgaço et al.14