The long-term use of NSAIDs, such as piroxicam, has been known to result in renal injury,
including renal papillary necrosis [42]. Interestingly, the highest risk of CKD was observed for
piroxicam and ketorolac which are known to have also the highest risk of other serious
NSAID-related side effects such as upper gastrointestinal risk [43, 44]. Renal toxicity may be a
risk particularly for patients in whom renal prostaglandins play a major role in maintaining
renal perfusion. In this case, the decrease in prostaglandin formation brought NSAIDs may reduce
renal blood flow and result in renal decompensation [42].