[Acute renal insufficiency with ketoprofen and clometacin]

Several recent reports emphasize the adverse effects of non-steroidal antiinflammatory drugs on renal function. These reports incriminate several phenylpropionates but none involve ketoprofen. There have been no indications that clometacin has renal toxicity. We report a case of acute renal failure which occurred during therapy with both ketoprofen and clometacin. The onset of renal failure after their administration, the return to normal renal function once therapy was discontinued and the absence of any other detectable etiology make the responsibility of the treatment very likely. The different possible mechanisms and the role of underlying disease and of associated therapy are discussed. In the index case the reduced excretion of urinary prostaglandin E2 suggests inhibition of prostaglandin synthesis rather than direct drug toxicity or an immuno-allergic mechanism.