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In the kidneys: Prostaglandins (PGE, PGI) help maintain renal blood flow They dilate the afferent arteriole, ensuring adequate glomerular perfusion When NSAIDs are used: Cyclooxygenase (COX) is inhibited Prostaglandin synthesis Afferent arteriole constricts Renal blood flow GFR Result: Acute kidney injury (AKI) Fluid retention Electrolyte imbalance High-risk groups: Elderly patients Dehydration Chronic kidney disease Concurrent use of ACE inhibitors or diuretics (Triple Whammy) Clinical insight: NSAIDs affect the afferent arteriole, while ACE inhibitors affect the efferent arteriole together, they can severely compromise renal filtration

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