Acute, Reversible Nonoliguric Renal Failure in Two Children Associated With Analgesic-Antipyretic Drugs

Abstract

Analgesic-antipyretic agents and nonsteroidal anti-inflammatory drugs are the most commonly used medications worldwide for the treatment of pain and fever in children. Acute renal failure is commonly seen in adults after treatment with analgesic agents. This complication has rarely been reported in children. Here, we describe 2 patients admitted to our hospital with acute nonoliguric renal failure temporally associated with ingestion of analgesic-antipyretic drugs at therapeutic doses. The first case was a 16-year-old adolescent boy, who had taken acetaminophen (APAP) and mefenamic acid for the indication of upper respiratory tract infection with daily doses of 1500 and 500 mg, respectively. His serum urea nitrogen and creatinine values were 16 and 1.6 mg/dL. The second case was a 12-year-old boy, who had taken APAP with a daily dose of 500 mg for abdominal pain. His serum urea nitrogen and creatinine values were 21 and 2.29 mg/dL. Both of them recovered with appropriate hydration within a week. Over-the-counter analgesic-antipyretic agents seem innocent but carry the risk of acute renal failure even at therapeutic doses. We believe that increased caution and awareness of the toxic effects of APAP and nonsteroidal anti-inflammatory drugs are needed. We suggest that clinicians should be careful while using analgesic-antipyretic-anti-inflammatory drugs especially in children with subclinical dehydration.

Significant Acute Kidney Injury Due to Non-steroidal Anti-inflammatory Drugs: Inpatient Setting

“…Though all children admitted to taking NSAIDs, such as ibuprofen and naproxen, the exact dose and duration could not be scientifically confirmed. Similar dilemma has been documented by other researchers investigating the exact relationship between dose of NSAIDs consumed and AKI [2,3,6]. Authors have described the amount of NSAIDs ingested as “the dosage within therapeutic limits” and “clinically prescribed limits” [2,3,6].…”

“…NSAIDs are a known cause of AKI, yet as an entity they may remain under diagnosed because the kidney failure is often moderate, asymptomatic, transitory, and non-anuric [2,10]. Under normal physiological conditions, renal blood flow is either independent of prostaglandin synthesis or, under certain circumstances, there is activation of the renin-angiotensin system.…”

“…When circulating vasoconstrictors are released and to maintain renal blood flow, counter-regulatory prostoglandins are released [10]. NSAIDs exert antipyretic, analgesic, and anti-inflammatory effects by reducing vasodilatory prostaglandin biosynthesis [2]. AKI can occur from NSAID induced renal interstitial inflammation, resulting in AIN.…”

“…Due to this function, the renal arterioles and glomerular capillaries are especially vulnerable to the effects of drugs [1]. Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used over-the-counter (OTC) medications in the United States and are known to have adverse effects on kidney function [2]. OTC NSAIDs, including ibuprofen, are routinely administered to children or taken by teenagers for pain and fever [3].…”

“…Use of NSAIDs has increased dramatically during recent years, especially in children in the United States [4]. Because of their frequent and accepted use, NSAIDs are widely considered safe, but in reality, even therapeutic doses carry a risk of loss of renal function [2]. …”