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Prostaglandins are involved with promoting various renal functions. Therefore, NSAIDs, like indomethacin which inhibits protaglandin formation through COX enzyme inhibition, tend to have many side-effects related to the kidneys.

Since corticosteroids like prednisone also affects prostaglandin synthesis, why are there relatively fewer kidney-related side-effects of corticosteroids compared to NSAIDs?

Arachidonic pathway from http://tmedweb.tulane.edu/pharmwiki/doku.php/introduction_to_eicosanoids

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  • Can you find some source that directly compares the frequency of renal side effects due to steroids and NSAIDs? My first thoughts were that some NSAIDs are available without prescription, so more commonly used and, I think, in average, people tend to take NSAIDs for longer periods than steroids. – Jan May 29 at 14:22
  • Actually I haven’t been able find any source that says steroids have any kidney-related effects at all. – D.Tan May 29 at 16:05
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Corticosteroids block the enzyme Phospholipase A2 (PLA2) which catalyses the first step in arachidonic acid synthesis pathway. But, NSAIDs blocks activity of cyclooxygenases (COX 1 and COX 2).

So, by blocking this pathway at first step completely prevents the formation of of Arachidonic acid, but when this pathway is blocked later at step performed by COX enzyme, other inflammatory pathways are still active which are performed by Lipoxygenases (LOX). LOX enzyme is involved in synthesizes of leukotrienes which are responsible for inducing inflammatory damage to kidneys. enter image description here

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  • The lack of leukotrienes with steroids could explain less inflammatory damage to the kidneys, but prostaglandins are also important for maintaining GFR. Couldn’t steroids still lead to renal failure because of reduced GFR? – D.Tan May 29 at 17:47
  • Prostaglandin synthesis is blocked by both drugs. Yes, steroids still can lead to renal damage, but it is less compared as compared to NSAID beacuse of the degree of inflammation. .And it is reported that Prednisone enhances the GFR. (Reference: pubmed.ncbi.nlm.nih.gov/8247189) – Twinkle Sheen May 29 at 18:25

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