NSAID Renal Risk Assessment

Assesses risk factors for NSAID-induced nephrotoxicity and acute kidney injury based on KDIGO criteria, age, comorbidities, and concomitant medications. Provides risk stratification to guide analgesic selection.

years
Age >65 years is a major risk factor for NSAID nephrotoxicity.
Any stage of CKD significantly increases AKI risk with NSAIDs.
Heart failure is a major risk factor due to hemodynamic dependence on prostaglandins.
Cirrhosis with ascites - NSAIDs contraindicated due to risk of HRS-AKI.
Volume depletion increases AKI risk by reducing renal perfusion.
Hypertension increases risk; NSAIDs also worsen BP control.
Diabetes is a risk factor for diabetic nephropathy and AKI.
Nephrotoxic medication combinations synergistically increase AKI risk.

Select risk factors and click Calculate to see assessment.

Note

Risk stratification adapted from KDIGO and multiple clinical guidelines. In high-risk patients, consider topical NSAIDs (lower systemic absorption) or non-pharmacologic therapies as first-line. COX-2 inhibitors have lower GI but similar renal/cardiovascular risks.

Warnings & Limitations

  • NSAIDs cause both hemodynamic AKI (prerenal) and interstitial nephritis.
  • Risk is dose and duration dependent - even low-dose ibuprofen increases risk.
  • All NSAIDs (including COX-2 selective) have renal risks, though non-selective may have higher risk.
  • In cirrhosis with ascites, NSAIDs are contraindicated due to hepatorenal syndrome risk.
  • Elderly patients (>65) have 3x higher AKI risk with NSAIDs.
  • This calculator provides guidance but does not replace clinical judgment.

References

  1. AKI and drugs: Paracetamol, NSAIDs, and nephrotoxicity — Clinical Kidney Journal / Oxford (2024)
  2. NSAIDs and kidney disease - Renal Unit — Renal Unit (renal.org) (2023)