Question:medium
A 50 yr old patient with renal insufficiency was recently operated for pyelolithotomy. Which drug will you give for post-operative analgesia?
A 50 yr old patient with renal insufficiency was recently operated for pyelolithotomy. Which drug will you give for post-operative analgesia?
Show Hint
All NSAIDs are contraindicated in renal insufficiency; choose the analgesic that does not act on COX enzymes.
Updated On: Jun 23, 2026
- Diclofenac sodium
- Naproxen
- Indomethacin
- Acetaminophen
Show Solution
The Correct Option is D
Solution and Explanation
Pharmacological safety in renal insufficiency:
Post-pyelolithotomy patient with pre-existing renal insufficiency - the key is to avoid nephrotoxic analgesics.
NSAIDs mechanism of nephrotoxicity:
NSAIDs inhibit COX $\Rightarrow$ decreased prostaglandins (PGE2, PGI2) $\Rightarrow$ afferent arteriolar vasoconstriction $\Rightarrow$ reduced GFR $\Rightarrow$ worsening renal function.
All three NSAIDs listed (diclofenac, naproxen, indomethacin) are therefore contraindicated:
Acetaminophen (Paracetamol):
Acts via central COX-3 pathway & endocannabinoid system. Does NOT reduce renal prostaglandins. Safe for use in CKD/renal insufficiency at appropriate doses. Recommended by multiple nephrology guidelines as the preferred analgesic in renal disease.
\[\boxed{\text{Acetaminophen (Option D)}}\]
Post-pyelolithotomy patient with pre-existing renal insufficiency - the key is to avoid nephrotoxic analgesics.
NSAIDs mechanism of nephrotoxicity:
NSAIDs inhibit COX $\Rightarrow$ decreased prostaglandins (PGE2, PGI2) $\Rightarrow$ afferent arteriolar vasoconstriction $\Rightarrow$ reduced GFR $\Rightarrow$ worsening renal function.
All three NSAIDs listed (diclofenac, naproxen, indomethacin) are therefore contraindicated:
- Diclofenac: selective COX-2 inhibitor, but still nephrotoxic
- Naproxen: non-selective COX inhibitor, nephrotoxic
- Indomethacin: most potent NSAID, most nephrotoxic
Acetaminophen (Paracetamol):
Acts via central COX-3 pathway & endocannabinoid system. Does NOT reduce renal prostaglandins. Safe for use in CKD/renal insufficiency at appropriate doses. Recommended by multiple nephrology guidelines as the preferred analgesic in renal disease.
\[\boxed{\text{Acetaminophen (Option D)}}\]
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