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Abstract: FR-PO968

Unexpected Improvement of CKD After Removal of Over-the-Counter Agent

Session Information

Category: CKD (Non-Dialysis)

  • 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials


  • Perez Cordero, Gabriel Daniel, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Santiago-Gonzalez, Juan Carlos, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Leal, Enrique, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Barletta Farias, Jorge B., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico

Prescription and over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) represent an important component in the treatment of acute and chronic pain. Products containing salicylates are one of the most widely used medications. They can be found in topical ointments, lotions, solutions used in hot steam, and oral and topical analgesia. Approximately 10-30% of salicylates are excreted via the kidneys as free salicylic acid but it is unknown whether the efficacy may be due to direct local absorption or the result of systemic absorption and distribution throughout the vasculature. Here we present a worsening of chronic kidney disease with OTC topical analgesic.

Case Description

Case of a 65-year-old male with a past medical history of CHF, DM2 and CKD who presented with shortness of breath. Patient with bilateral lung crackles and peripheral edema, who was admitted due to decompensated CHF. Medication regimen included apixaban, atorvastatin, metoprolol succinate, lisinopril, spironolactone and empagliflozin, and NSAIDs use was denied. Laboratory remarkable for worsening renal function. Patient's nephrotoxic medications were placed on hold and his creatinine level started to improve after careful IV diuresis. Upon achieving euvolemia, the diuretic was transitioned to oral. All of a sudden his renal function started to decline. Renal ultrasound resulted with no obstructive uropathy but with cortical thinning and increased echotexture. Urinalysis was remarkable for few epithelial cells. FEUrea resulted in 41.7% suggestive of intrinsic damage. Upon further questioning, the patient had been using a topical methyl-salicylate every 4 hours for articular and muscle pain without disclosing it for 48-72 hours. Once topical NSAIDs were removed, and IV hydration was implemented the serum creatinine gradually returned to baseline in the following days.


Topical NSAIDs has been less associated with renal impairment than the oral route. Around 9.3% of patients with salicylate poisoning develop AKI and increased risk of organ failure, in-hospital mortality, longer length of hospital stay, and higher cost of hospitalization. This case highlights the importance of a careful review of patients' medication history including OTC medication and raises concern of potential role and impact on renal function not well known by topical NSAIDs.