What might chronic use of NSAIDs lead to aside from gastric issues?

Chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) can indeed lead to kidney damage. NSAIDs work by inhibiting enzymes involved in the inflammatory process, which can also affect the renal system. The kidneys rely on a delicate balance of prostaglandins to maintain normal blood flow and filtration. Prostaglandins help dilate blood vessels in the kidneys, allowing adequate blood supply. Inhibiting these compounds can lead to a reduction in renal blood flow, potentially resulting in acute kidney injury or exacerbating chronic kidney disease. This risk is particularly heightened in individuals who are dehydrated, have existing renal impairment, or are taking other medications that can also affect renal function.

The other options, while they may seem plausible in some contexts, do not align with the established effects of prolonged NSAID use. For instance, improved liver function, enhanced energy levels, and better absorption of nutrients are not direct consequences of NSAID use and do not reflect the negative impact these medications can have on the kidneys and gastrointestinal tract.