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Acute nonoliguric renal failure in children associated with nonsteroidal antiinflammatory agents
1Department of Pediatrics, The Children's Hospital of Philadelphia, and the University of Pennsylvania, 19104, USA.
Insights
Acute kidney injury from nonsteroidal anti-inflammatory drugs (NSAIDs) is rare in children. This study found four pediatric cases of acute nonoliguric renal failure linked to NSAID ingestion, with most recovering fully.
Area of Science:
- Pediatric Nephrology
- Clinical Toxicology
- Pharmacovigilance
Background:
- Nonsteroidal anti-inflammatory agents (NSAIDs) are frequently used for pain and inflammation.
- Acute renal failure (ARF) is a known complication of NSAID use in adults.
- ARF associated with NSAIDs is rarely reported in pediatric populations.
Observation:
- A case series involving four pediatric patients (ages 3.5-19 years) admitted with acute nonoliguric renal failure.
- All patients had ingested NSAIDs prior to the onset of renal failure.
- Exclusion of other causes of renal failure such as hemolytic uremic syndrome, systemic lupus, dehydration, obstructive uropathy, and sickle cell disease.
Findings:
- NSAID-induced acute nonoliguric renal failure occurred in four pediatric patients.
- Patients presented with elevated serum creatinine levels without oliguria, anuria, or significant electrolyte abnormalities.
- Three out of four patients experienced a rapid return to normal renal function following discontinuation of NSAIDs.
Implications:
- The increasing availability of over-the-counter NSAIDs may lead to a rise in pediatric cases of NSAID-associated acute kidney injury.
- Clinicians should maintain a high index of suspicion for NSAID-induced renal toxicity in children presenting with acute renal failure.
- Prompt recognition and management, including NSAID withdrawal, are crucial for favorable outcomes in pediatric NSAID nephrotoxicity.
Objective:
Acute renal failure is commonly seen in adults after treatment with nonsteroidal antiinflammatory agents. This complication has rarely been reported in children.
Design:
Four consecutive patients admitted with acute nonoliguric renal failure associated with ingestion of nonsteroidal antiinflammatory agents.
Setting:
The emergency department and ward units at The Children's Hospital of Philadelphia.
Patients:
Four patients, ages 3.5 to 19 years.
Interventions:
Appropriate evaluations including measurement of serum creatinine concentrations in the emergency department and careful histories of drug ingestion.
Main Outcome Measure:
Rapid return to normal serum creatinine concentrations.
Results:
Four patients were admitted to The Children's Hospital of Philadelphia between May 1996 and June 1997 with a diagnosis of acute, nonoliguric renal failure following ingestion of nonsteroidal antiinflammatory agents. None of the patients had features of hemolytic uremic syndrome, systemic lupus, dehydration, obstructive uropathy or sickle cell disease. Each patient had ingested nonsteroidal antiinflammatory agents before the onset of acute renal failure. None had oliguria or anuria, dehydration, abnormal serum electrolyte concentrations, or evidence of glomerulonephritis. One patient also had a urinary tract infection that was treated with antibiotics. Another patient was treated with methylprednisolone and prednisone. None was biopsied. Three recovered completely.
Conclusion:
With the increasing use of over-the-counter nonsteroidal antiinflammatory agents, this association may become more prevalent.