Maternal ingestion of diclofenac leading to renal failure in newborns

The use of non-steroidal anti-inflammatory drugs, such as indomethacin, ibuprofen, and nimesulide, during pregnancy has been reported to cause nephrotoxicity in the fetus. However, neonatal renal failure following antenatal exposure to diclofenac has not been reported in the literature. We report three cases of neonatal renal failure, including a pair of twins, following ingestion of diclofenac by the mother during pregnancy.

Cases 1 and 2 involved a pair of twins born to a mother with oligohydramnios. The first twin had nonoliguric renal failure with incomplete recovery at day 17 of life. The second twin developed anuria and hyperkalemia on day 2 of life, for which peritoneal dialysis was initiated. After 20 days of peritoneal dialysis, the second twin remained oligo-anuric, developed peritonitis, and died. Case 3 involved a female infant born to a primigravida with severe oligohydramnios. The baby developed oliguria and renal failure after birth, which was managed conservatively. Creatinine normalized by day 15 of life and remained normal at 1 year of age. Ultrasonography in the first week of life showed that all three infants had normal-sized kidneys. Both mothers had been administered diclofenac during pregnancy.

In utero exposure to diclofenac may be associated with neonatal renal failure that may be transient or irreversible. We recommend that the use of diclofenac during pregnancy be avoided.