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Perinatal vasoconstrictive renal insufficiency associated with maternal nimesulide use
D Landau1, I Shelef, H Polacheck
1Department of Pediatrics, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel.
American Journal of Perinatology
|April 25, 2000
Summary
Maternal use of nimesulide during pregnancy can cause fetal renal failure. This non-steroidal anti-inflammatory drug may lead to severe vasoconstriction and oliguric renal failure in newborns.
Area of Science:
- Neonatal Medicine
- Pharmacology
- Nephrology
Background:
- Nimesulide, a selective cyclo-oxygenase-2 inhibitor, is a non-steroidal anti-inflammatory drug.
- Maternal ingestion of nimesulide during late pregnancy is investigated for potential fetal adverse effects.
Observation:
- A full-term newborn presented with oliguric renal failure within 24 hours of birth.
- The infant's mother had taken therapeutic doses of nimesulide in the final two weeks of gestation.
- Maternal complications included oligohydramnion, esophagitis, and a bleeding peptic ulcer.
Findings:
- The infant exhibited a very low fractional excretion of sodium (0.5%), indicating severe vasoconstriction.
- Renal sonography revealed hyperechogenic medullary papillae, which normalized during recovery.
- This case is the first to report fetal renal circulatory adverse effects from maternal nimesulide ingestion.
Implications:
- Highlights the critical role of renal prostaglandins in maintaining fetal vascular tone and sodium balance.
- Underscores the potential risks of NSAID use during pregnancy, particularly affecting fetal renal function.
- Suggests careful consideration of nimesulide use in pregnant patients due to potential neonatal complications.