COX-2 inhibitors and the kidney

Cyclooxygenase-2 (COX-2) selective inhibitors are now extensively used for their anti-inflammatory and analgesic efficacy. Several large controlled tr ials provide evidence to support the proposition that they cause fewer majo r gastro-intestinal side effects and less toxicity than routine nonsteroida l antiinflammatory drugs (NSAIDs). In view of the documented different loca lizations of the cyclooxygenase-1 and COX-2 enzymes in the kidney, it was i nitially hoped that COX-2 inhibitors would be associated with fewer renal s ide effects than other NSAIDs. This has not been borne out by subsequent studies. Like other NSAIDs, COX-2 inhibitors can cause salt and water retention, leading to edema and worsen ing hypertension. They can also cause acute declines in renal function and glomerular filtration rate. These events are, however, uncommon in large rh eumatology populations and infrequently lead to discontinuation of the medi cations. Judicious use of COX-2 inhibitors in high-risk patients (such as t hose with chronic renal insufficiency, diabetes or congestive heart failure ) will lead to a decreased incidence of adverse renal events.