Therapeutics in rheumatology and the kidney.

This article reviews the safety and prescribing considerations of medications used to treat rheumatic diseases in patients with chronic kidney disease (CKD). It discusses traditional treatments such as non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids (CSs), and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), as well as newer biologic DMARDs (bDMARDs), targeted synthetic DMARDs (tsDMARDs), and anti-gout therapies. The review highlights that NSAIDs pose significant nephrotoxic risks, especially in advanced CKD, while CSs have no direct nephrotoxicity but may exacerbate hypertension and diabetes. Biologic DMARDs generally have minimal renal clearance due to their large molecular size, but rare immune-mediated kidney toxicities have been reported, necessitating close monitoring. Dose adjustments are often required for csDMARDs, JAK inhibitors, and anti-gout medications in CKD, with recommendations varying by drug and CKD stage. The article emphasizes the need for further research on dosing in advanced CKD and advocates for vigilant renal function monitoring during treatment.