Pharmacology · single question
A patient presents with low back pain and has been taking ibuprofen regularly. Their dentist notices recurrent gingival lesions and chronic kidney disease stage 3. What is the MOST likely concern with continuing NSAID use?
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Correct answer: D. NSAIDs decrease GFR and worsen CKD
NSAIDs reduce GFR (glomerular filtration rate) by inhibiting prostaglandins that maintain renal afferent arteriole dilation. In patients with CKD, renal perfusion already depends heavily on prostaglandins — NSAIDs can precipitate acute kidney injury on top of chronic kidney disease, accelerating renal decline. NSAIDs are a relative contraindication in CKD and should be minimized or avoided, especially in stage 3 or higher.
- A. ❌ Peptic ulcer is a significant NSAID complication but the question focuses on the CKD context.
- B. ❌ NSAID-induced asthma (Samter's triad) is a separate condition — COX inhibition causes leukotriene overproduction causing bronchospasm in susceptible patients.
- C. ❌ Hepatorenal syndrome is caused by liver failure-associated renal impairment — not directly by NSAIDs in a CKD patient.
- D. ✅ CORRECT – NSAIDs reduce GFR by inhibiting prostaglandin-mediated afferent arteriolar dilation, worsening CKD.