Indomethacin-induced azotaemia and hyperkalaemia: a case study

We present a patient in whom indomethacin treatment for acute gouty arthritis induced reversible azotaemia and hyperkalaemia. Re-introduction of the drug under controlled conditions of metabolic balance resulted in recurrence of hyperkalaemia and azotaemia, and was associated with a fall in plasma renin activity, but no change was observed in plasma aldosterone. Since potassium retention and hyperkalaemia occurred in the absence of hypoaldosteronism, other factors must be invoked to explain the observed upset in potassium homeostasis. This, and other recent case reports suggest that prostaglandin synthetase inhibitors such as indomethacin should be used with caution, especially in patients with pre-existing azotaemia, congestive heart failure, or gout.