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Nephrotoxicity of selective COX-2 inhibitors
A Woywodt1, A Schwarz, M Mengel
1Department of Medicine, University of Hannover School of Medicine, Germany. Woywodt.Alexander@MH-Hannover.de
Abstract:
We describe 2 male patients, a 49-year-old with psoriatic arthritis and impaired renal function and a 43-year-old renal transplant recipient, who both sustained a marked decline in glomerular filtration rate in conjunction with a selective inhibitor of cyclooxygenase-2 (COX-2), rofecoxib. In the second patient, acute renal failure necessitated hemodialysis. Both patients made an uneventful recovery. Our report lends further support to the assumption that COX-2 inhibitors, as a class, can be as nephrotoxic as their nonselective predecessors. Therefore, COX-2 inhibitors should be used with caution in renal transplant recipients and in patients with salt depletion and renal insufficiency.
Insights
Selective cyclooxygenase-2 (COX-2) inhibitors, like rofecoxib, can impair kidney function, causing acute renal failure in susceptible patients. Caution is advised when prescribing these drugs to individuals with renal insufficiency or those who have undergone kidney transplants.
Area of Science:
- Nephrology
- Pharmacology
Background:
- Cyclooxygenase-2 (COX-2) inhibitors are a class of drugs designed to reduce inflammation and pain.
- Concerns exist regarding the potential nephrotoxicity of selective COX-2 inhibitors, similar to nonselective nonsteroidal anti-inflammatory drugs (NSAIDs).
Observation:
- Two male patients, one with psoriatic arthritis and impaired renal function, and another a renal transplant recipient, experienced a significant decrease in glomerular filtration rate (GFR).
- This decline in GFR coincided with the administration of rofecoxib, a selective COX-2 inhibitor.
- One patient developed acute renal failure requiring hemodialysis.
Findings:
- The cases suggest that selective COX-2 inhibitors can cause substantial nephrotoxicity.
- Both patients recovered fully after discontinuation of the drug and appropriate management.
Implications:
- COX-2 inhibitors should be used cautiously in patients with pre-existing renal insufficiency.
- Renal transplant recipients represent a high-risk group for COX-2 inhibitor-induced nephrotoxicity.
- These findings support the notion that COX-2 inhibitors share nephrotoxic potential with traditional NSAIDs.