A recent review published in the journal Pharmacotherapy concluded that COX-2 inhibitors, pharmaceutical anti-inflammatory agents used to treat diseases such as rheumatoid arthritis, can cause kidney failure, especially in susceptible individuals.

The authors of the article presented a case study of a 71-year-old woman who developed acute renal failure after receiving a 50-mg dose of the selective COX-2 inhibitor rofecoxib. They then go on to review the literature on COX-2 inhibitors and renal failure.

Prior to the introduction of COX-2 inhibitors, the anti-inflammatory treatment of choice was often non-steroidal anti-inflammatory drugs (NSAIDS), which were known to inhibit both COX-2 and COX-1. The inhibition of COX-1, however, was associated with gastrointestinal bleeding and ulceration and NSAIDS could also cause renal toxicity, including acute renal failure. The introduction of selective COX-2 inhibitors created a new way to produce anti-inflammatory actions with a decreased risk of significant gastrointestinal adverse effects.

Until recently, it was thought that only COX-1 was expressed in the kidneys. Consequently, the administration of selective COX-2 inhibitors would not cause the kidney damage that could occur with NSAIDs. However, recent evidence indicates that COX-2 also is expressed in the human adult kidney.

The reviewers in the Pharmacotherapy article set out to explore whether COX-2 inhibitors can also have a devastating effect on kidney function, as presented in the medical literature. They point out that
in vitro and clinical studies have begun to create a clearer picture of the role the COX-2 enzyme plays in renal function and that case reports of selective COX-2 inhibitor-associated acute renal failure are emerging.

The reviewers looked at four human studies, which investigated how COX-2 inhibitors affected the kidneys. The reviewers concluded that COX-2 inhibitors can inhibit the release of prostaglandins in the kidney, which is thought to be the mechanism behind which NSAIDS exert their detrimental effects as prostaglandins are necessary for proper kidney function. One study demonstrated that the deleterious renal effects caused by selective COX-2 inhibition in sodium-depleted persons may not be limited to older individuals but may also occur in healthy young adults.

Anyone seeking to avoid the detrimental effects that can occur with pharmaceutical COX-2 inhibitors can try turmeric, which has been shown to be a natural COX-2 inhibitor. According to results of a study in the UK, turmeric was found to inhibit the production of COX-2. This may explain why so many people experience relief from arthritis pain by taking substantial doses of turmeric. In fact, the Arthritis Foundations Guide to Alternative Therapies, (page 229) by Judith Horstman, acknowledges that there may well be some anti-inflammatory properties in turmeric that can be beneficial to arthritis sufferers.

Reference:
Enid Morales, Pharm.D., Jeffrey J. Mucksavage, Pharm.D. Cyclooxygenase-2 Inhibitor-Associated Acute Renal Failure: Case Report With Rofecoxib and Review of the Literature. Pharmacotherapy. 2002; 22(10):1317-1321.

The information in this article is not intended to provide personal medical advice, which should be obtained from a medical professional, and has not been approved by the U.S. FDA.

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