Which NSAID is generally avoided in chronic kidney disease due to risk of further renal impairment?

• A. Naproxen
• B. Acetaminophen
• C. Prednisone
• D. Methylprednisolone

Answer: (A)

NSAIDs reduce prostaglandin production, and those prostaglandins help keep kidney blood flow stable by dilating the afferent arteriole. In chronic kidney disease, this mechanism is especially important to maintain GFR, so blocking it with an NSAID can drop renal perfusion and worsen kidney function or trigger acute kidney injury. Naproxen is a common NSAID, so it’s the one generally avoided in CKD to prevent further renal impairment. Acetaminophen isn’t an NSAID and has minimal impact on renal perfusion at standard doses, making it a safer option for pain in CKD (though dosing limits apply for liver safety). Prednisone and methylprednisolone are corticosteroids, not NSAIDs, so they don’t carry the same risk to renal perfusion, though they have their own systemic side effects.