NSAIDs decrease prostaglandin-induced inflammation
by inhibiting the cyclooxygenase (COX) enzymes
COX-1 and COX-2 and thereby blocking
prostaglandin synthesis. Unfortunately, in doing so, NSAIDs interfere with the protective role of prostaglandins
in the kidney—regulating the release of renin,
salt, and water, as well as balancing glomerular vascular tone (vasoconstriction or vasodilation).26
When renal perfusion is compromised owing to hypovolemia,
dehydration, hypotension, or blood loss,
NSAIDs may exacerbate the problem