Numerous drugs can cause renal insufficiency, or facilitate its progression, so they should be used with particular caution. The so-called NSAIDs (non-steroidal anti-inflammatory drugs) are the most often used painkillers (e.g. nimesulide, ketoprofen, diclofenac, ibuprofen, naproxen, piroxicam, ketorolac, meloxicam – sold under various trade names). These drugs can cause damage by reducing the inflow of blood to the kidney, or by interfering with the arachidonic acid, prostaglandin and prostacyclin systems. The end-result is a reduction in the blood flow to the glomeruli, with a consequent decline in glomerular filtration, and an increase in creatinine and blood nitrogen levels, and arterial blood pressure. This condition may even be irreversible. It can be important in patients with chronic kidney disease (CKD), who have a more limited functioning nephron mass, and vessel constriction due to hyperfiltration; and it is particularly important for diabetic patients with CKD, who already have a tendency for vessel constriction, which is exacerbated by the use of NSAIDs.