Screening Liver & Kidney Values Prior to NSAIDs

In the Literature

Chalifoux NV, Kaiman G, Drobatz KJ, Thawley VJ. Evaluation of renal and hepatic blood value screening before non-steroidal anti-inflammatory drug administration in dogs. J Small Anim Pract. 2021;62(1):12-18.

The Research …

NSAIDs are commonly prescribed in veterinary medicine, but there are concerns regarding safety profiles of these drugs.^1-3 Reported adverse effects include anorexia; lethargy; vomiting; gastric irritation, ulceration, and perforation; renal insufficiency; and idiosyncratic hepatotoxicity.

In this retrospective study, medical records of 81 dogs with laboratory evaluations conducted in advance of NSAID therapy were reviewed. Of these, 56% had an elevation in at least one renal (ie, BUN, creatinine) or hepatic (ie, ALP, ALT, AST) value, which are often reflective of renal perfusion, hepatocellular injury, and cholestasis.

Dogs with elevated hepatic blood values were less likely to have an NSAID administered, although this was not the case for an elevated renal parameter in isolation. This variation in administration may be due to the relatively low number of dogs with an elevated renal parameter, as opposed to a lack of concern for renal elevation. Results also suggested that dogs <8 years of age were less likely to have an elevated renal or hepatic blood value questioning screening utility in young, healthy, euvolemic patients. Other associations pertaining to patient history, physical examination, or onset of illness were not significant.

… The Takeaways

Key pearls to put into practice:

• Patients with compromised circulating volume (eg, dehydration, hypotension, GI losses, ascites, congestive heart failure) are at increased risk for adverse effects secondary to NSAID administration.

• Although risk factors for idiosyncratic, life-threatening hepatotoxicity are unknown, there is concern that NSAID administration may exacerbate pre-existing underlying hepatitis.⁴

• Regardless of physical examination and serum chemistry profile findings, pet owners should be informed of the possible adverse effects prior to an NSAID being administered and guided to seek medical care if adverse effects occur.