Monitoring of the renal function in Piroxicam treated patients with headache

Yzeiri Havziu, Drita and Gjorgjeska, Biljana and Alili Idrizi, Edita and Alija, Gjylaj and Lika, Sihana and Dauti, Merita (2020) Monitoring of the renal function in Piroxicam treated patients with headache. Knowledge - International Journal, Scientific Papers, 38.4 (4). ISSN 2545-4439

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Despite introducing more than three decades ago a new class of migraine-specific drugs with superior efficacy, triptans, NSAIDs remain the most commonly used therapies for migraine attack. Inhibition of NSAID-mediated prostaglandin synthesis prevents neurogen-mediated inflammation in the trigeminal-vascular system and reduces pain, but is also mediated through inhibition of prostaglandin synthesis by non-specific blocking cycloxygenase, leading to vasoconstriction and reversible mild renal failure. When undetected, this can lead to acute kidney injury (AKI). Non-steroidal anti-inflammatory drugs (NSAIDs) are considered one of the most nephrotoxic drugs. The purpose of this study was to evaluate the reversibility of nephrotoxicity in patients treated with Piroxicam with migraine-cephalea.
We used venous urine and blood from 12 patients with a mean age of 42.047 ± 7.41, with headaches >15 days per month, were evaluated during treatment with Piroxicam 20 mg and again after a 40-day break without treatment. The presented results represent the mean of three measurements, under identical conditions and compared with reference values for each parameter. Besides conventional markers of renal function (serum/urine creatinin determined by Jaffe methods, enzymatic assay for urea in serum), we used nephelometry by β2 Microgloglobulin (β2 M) and photoelectric colorimetry for microalbuminuria in urine, to monitor glomerular and tubular functioning. Present or past history of kidney disease was considered an exclusion criteria for enrollment in the study.

Based on the results, it is observed that patients treated with Piroxicam after 40 days without treatment had decreased values of all parameters analyzed, but significant decrease was confirmed for serum urea level by p = 0.007, creatinine p = 0.024, sodium p = 0.032 , potassium p = 0.008, chlorides in serum p = 0.043, microalbuminuria p = 0.043 and β2M for p = 0.002.

Reversible renal impairment is present at glomerular and tubular levels. The changes occurred were completely reversible after discontinuation of treatment, indicating that the reversible changes were due to nephrotoxic agents, not to the complication of the disease, but, after the rise of particular biomarkers, we can use them as early signals of nephrotoxicity. The safety level of Piroxicam 20 mg for chronic nephrotoxicity at therapeutic doses is high, as the recorded changes are reversible and after discontinuation of treatment, the condition is normalized. Continuous monitoring of patients is required.
Keywords: Biomarkers, Nephrotoxicity, Nonsteroidal antiinflamatory drugs, migrena.

Item Type: Article
Subjects: Medical and Health Sciences > Basic medicine
Medical and Health Sciences > Clinical medicine
Medical and Health Sciences > Health sciences
Divisions: Faculty of Medical Science
Depositing User: Biljana Gorgeska
Date Deposited: 23 Apr 2020 13:48
Last Modified: 23 Apr 2020 13:48

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