This is an important question raised by the viral headline.

If some medicines can affect the kidneys, why are they available?

Because risk does not automatically mean a medicine should not be used.

Every effective medicine involves a balance between potential benefits and potential risks.

For example, an NSAID might provide significant relief to someone experiencing severe inflammation.

An ACE inhibitor may help protect kidney function and reduce cardiovascular risk in an appropriate patient.

A diuretic may help someone with dangerous fluid accumulation.

An antibiotic may be necessary to treat a potentially serious infection.

The question isn’t simply:

“Can this medicine affect the kidneys?”

A much better question is:

“For this person, at this dose, for this length of time, does the benefit outweigh the risk?”

That decision belongs with the prescribing healthcare professional.

The Biggest Risk May Be Taking Medicines Without Checking the Combination

Sometimes the individual medications aren’t the only issue.

The combination can matter.

For example, an NSAID combined with an ACE inhibitor or ARB and a diuretic can increase the risk of acute kidney injury, especially when dehydration is also present. (National Kidney Foundation)

This is why pharmacists ask what other medicines you take.

Even over-the-counter products matter.

Someone may tell their doctor about their prescription medication but forget to mention:

Ibuprofen
Naproxen
Cold medicine
Vitamins
Herbal supplements
Weight-loss products
Sports supplements

NIDDK recommends keeping an up-to-date list of medicines and supplements and discussing them with healthcare professionals.

Dehydration Can Make the Situation Worse

Your kidneys need adequate blood flow to function normally.

Severe dehydration can reduce blood volume and affect kidney filtration.

That’s why taking certain medicines while severely dehydrated can be more dangerous than taking the same medicines under normal circumstances.

Situations that can cause dehydration include:

Severe diarrhea
Repeated vomiting
High fever
Heavy sweating
Not drinking enough fluids
Certain illnesses

NIDDK specifically recommends planning ahead with a healthcare professional about what to do with certain medicines if you become sick and dehydrated. (Institut National de Diabète et Digestif)

What Symptoms Could Suggest a Kidney Problem?

Kidney problems don’t always cause obvious symptoms in the early stages.

That’s one reason kidney function is often assessed with laboratory tests.

A healthcare professional may use a blood test to estimate kidney filtration, commonly reported as eGFR.

A urine test can also check for albumin or protein.

The National Kidney Foundation recommends monitoring kidney function with tests such as eGFR and urine albumin-creatinine ratio when appropriate. (National Kidney Foundation)

Possible symptoms of significant kidney problems can include:

Swelling
Changes in urination
Unusual fatigue
Nausea
Shortness of breath
Confusion
Changes in blood pressure

These symptoms can have many causes, so they cannot diagnose kidney disease by themselves.

Who Is at Higher Risk?

Certain people need to be particularly careful with medications that can affect kidney function.

Risk can be higher in people who already have:

Chronic kidney disease
Diabetes
High blood pressure
Heart failure
Older age
Dehydration
Certain medication combinations

NIDDK specifically highlights chronic kidney disease, diabetes, and high blood pressure as situations where medication choices deserve particular attention. (Institut National de Diabète et Digestif)

If you have any of these conditions, don’t assume an over-the-counter medicine is automatically safe simply because it is available without a prescription.