Indomethacin-associated acute renal failure

Area of Science:

• Nephrology
• Pharmacology
• Internal Medicine

Background:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin are commonly used for pain and inflammation.
• NSAIDs can affect renal function, particularly in susceptible individuals.
• Acute kidney injury (AKI) is a potential adverse effect of NSAID therapy.

Observation:

• A 61-year-old male patient developed oliguric acute renal failure during indomethacin treatment.
• The patient presented with significant proteinuria (5.1 g/24 hours) and hypertension.
• Renal function gradually improved after the discontinuation of indomethacin therapy.

Findings:

• The clinical presentation of oliguric acute renal failure, proteinuria, and hypertension in this patient suggests a direct link to indomethacin.
• Resolution of renal insufficiency, proteinuria, and hypertension upon drug withdrawal supports a diagnosis of drug-associated acute kidney injury.
• Indomethacin-induced nephrotoxicity can manifest as acute renal failure.

Implications:

• This case highlights the importance of considering drug-induced nephrotoxicity in patients presenting with acute kidney injury, especially those on NSAIDs.
• Clinicians should monitor renal function and urine protein levels in patients receiving indomethacin, particularly those with risk factors for kidney disease.
• Early recognition and discontinuation of the offending agent are crucial for favorable outcomes in drug-associated acute kidney injury.