Every year, millions of people turn to pain relievers, anti-inflammatories, and other over-the-counter medications to relieve a headache, lower a fever, or relieve muscle discomfort. What few know is that this seemingly harmless habit can become, over time, one of the main preventable causes of kidney damage.

Nonsteroidal anti-inflammatory drugs (NSAIDs)—such as ibuprofen, naproxen or diclofenac—are, along with common analgesics, the most consumed medications in the world, both by self-medication and by medical prescription, especially among children, young people and healthy adults who use them to treat fever and pain. Their popularity makes them almost invisible as a risk: they are taken without a prescription, without supervision and, often, without a time limit.

The data, however, is compelling. In the general population, the use of NSAIDs triples the risk of suffering a first episode of acute renal failure compared to those who do not consume them. The damage is not always immediately evident: the nephrotoxicity of these drugs can manifest itself as high blood pressure, water and sodium retention, excess potassium in the blood, inflammation of the kidney tissue or directly acute kidney failure, notes the digital organ of Elsevier, a global information analysis company based in the Netherlands that specializes in scientific, technical and medical content.

From punctual discomfort to chronic damage

El problema se agrava con el uso prolongado. According to nephrotoxicity specialists, chronic exposure to NSAIDs can produce severe kidney injury with a poor prognosis, characterized by inflammation of the interstitial tissue, scar formation, atrophy of the renal tubules and fibrosis. That is to say, it is not only an acute and reversible risk, but a condition that can establish itself progressively and silently.

The combination of drugs worsens the situation. Specialists warn about the so-called “triple whammy effect”: combining an NSAID with angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor antagonists (ARBs) together with diuretics generates a high risk of kidney failure. This is a common combination in older people who manage hypertension and chronic pain at the same time, often without any professional reviewing the complete interaction of their treatment.

Who is most at risk?

The damaged or weakened kidney is especially vulnerable. In patients with previous kidney failure, the already reduced filtration capacity increases vulnerability to the toxic effects of NSAIDs, which makes these medications a double-edged sword: they relieve the symptom, but can accelerate the deterioration of the organ that processes them.

This phenomenon is not limited to NSAIDs. Other pharmacological groups—radiological contrast media, certain antifungals, immunosuppressants such as cyclosporine and tacrolimus, and even angiotensin-converting enzyme inhibitors themselves—are among the drugs with the greatest nephrotoxic potential. The mechanism of damage varies: some directly affect the tubular cells, others alter renal blood flow, and others generate allergic or inflammatory reactions in the kidney tissue.

It is known that in hospital environments the problem intensifies. In intensive care units, the incidence of acute renal failure can reach up to 60% of critically ill patients, and about 20% of these cases require renal replacement therapy, with associated mortality rates exceeding 60% in developing countries.

Disease that progresses silently

One of the most worrying aspects of so-called analgesic nephropathy is its silent course. It is possible that there are no symptoms at first, and that these appear only when the drug has already damaged the kidneys, at which time the damage can be much more difficult to reverse. Among the antecedents that increase the risk is also the excessive and prolonged use of other drugs such as tranquilizers, which confirms that the problem is not exclusive to a single type of medication, but to pharmacological abuse in general.

Prevention is the only real defense

Faced with this panorama, medical recommendations agree on one point: prudence. It is essential to evaluate kidney function before resorting to NSAIDs and opt for less nephrotoxic alternatives when possible, in addition to maintaining constant monitoring in those who do require their use. The simplest, but most often ignored, guideline is summarized by MedlinePlus: do not take more than the recommended dose without first consulting a health professional.

Self-medication with painkillers and anti-inflammatories has become normalized to such an extent that it is rarely perceived as a real risk. However, the medical evidence is clear: the kidneys, silent organs that rarely warn when something is wrong, can pay a high price for decisions that are often made without a second thought in front of the home medicine cabinet.

You may also be interested in:

· How to differentiate viral and bacterial infections to guide treatment · How healthy is it to artificially raise testosterone? The Trump administration's bet divides the medical community Learn about 5 natural anti-allergy medications before resorting to drugs