Avaliação da função renal através de biomarcadores convencionais e não-convencionais pré e pós uso de AINEs

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely used for over a century to relieve pain and inflammation, despite their prolonged use being associated with impaired renal function. Although experimental and clinical data have addressed this topic for decades, there remains a knowledge gap regarding the individual nephrotoxic potential of the most commonly used NSAIDs in Brazil, even when consumed short-term. This study aimed to evaluate renal function in patients exposed to acute (7-day) therapeutic doses of NSAIDs with different selectivities for COX-1 and COX-2 (ketoprofen, etodolac, and nimesulide) using conventional biomarkers (creatinine, urea, and cystatin C) and non-conventional biomarkers (enzymuria). The study was conducted with 60 patients in the district of Itaperuna, Boa Ventura, RJ. Conventional biomarkers showed no significant changes across evaluation times (T0, T3, and T7; p>0.05), except for a 13% increase in urea levels at the end of ketoprofen treatment (T0: 34 ± 10 vs. T7: 39 ± 11 mg/dL; p<0.05). Among non-conventional biomarkers, enzymuria revealed a 35% increase in GGT on the third day of etodolac treatment (42 ± 28 vs. 57 ± 30; p<0.05). When enzymuria was corrected for urinary creatinine, a 3-fold increase in TGO levels was observed throughout ketoprofen treatment (p<0.05) and a 2-fold increase in LDH was detected in the etodolac group, only on the seventh day (p<0.05). Other parameters, such as hepatic function, blood and urinary electrolytes, and proteinuria, showed no significant changes (p>0.05). It is concluded that, according to the conventional biomarkers evaluated, acute use of the investigated NSAIDs at therapeutic doses does not transiently impair renal or hepatic function, nor disrupt electrolyte balance, indicating safety for acute use in the evaluated groups. However, enzymuria suggests a higher risk of tubular damage in individuals treated with ketoprofen, even at therapeutic doses. Our study opens new opportunities for future investigations into the safety of the most commonly used NSAIDs in Brazil, including in more vulnerable groups (such as nephropaths and diabetics), encouraging the expansion of clinical evaluation using the enzymuria method for AST and LDH, given its relevance, ease of execution, and low cost.