Effect of Diclofenac on Renal Function and Prostacyclin Generation After Surgery

Abstract

We have examined the effect of diclofenac on renal function after major surgery in a randomized, double-blind, controlled study of 20 patients undergoing oesophagogastrectomy. Diclofenac 75 mg or placebo was given i.m. 12-hourly for 2 days. I.v. fluid administration was standardized. Renal function was assessed by fluid balance and measurement of serum creatinine and electrolyte concentrations, creatinine and free water clearance, and urinary sodium and potassium excretion. Urinary 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha) was measured by radioimmunoassay to assess renal prostacyclin production. After surgery, 6-keto-PGF1 alpha production increased, but this did not occur with diclofenac. On the first day after surgery, use of diclofenac was associated with a decreased urine flow rate, decreased urinary sodium and potassium excretion and a tendency to hyperkalaemia. Frusemide was required more often in the diclofenac group. One patient was withdrawn from the diclofenac group because of impaired renal function. Urine flow rate and blood potassium concentration should be monitored if diclofenac is used after major surgery.

Renal involvement in dogs with babesiosis

“…Further sodium reabsorption occurs in the distal convoluted tubules (secondary to the active re-absorption of chloride ions) and collecting ducts (controlled by aldosterone) 34 . In this study, the lower FCNa can be interpreted as either renal retention of sodium secondary to aldosterone secretion or inhibition of prostaglandins, or as a result of activation of the renin-angiotensin-aldosterone system, in response to renal arterial hypotension 15,27,30 . The well-concentrated urine in all dogs with babesiosis can also be attributed to sodium and water retention.…”

Effect of administration of nonsteroidal anti-inflammatory drugs before surgery on renal function in clinically normal dogs

“…2,4 In hypotension caused by hemorrhage, salt depletion, or anesthesia, autoregulation of renal blood flow and glomerular filtration is dependent on prostaglandins. 6 Naproxen, diclofenac sodium, ketorolac tromethamine, and ibuprofen have been used before surgery in humans. 2 There is also evidence that prostaglandins may be important in maintaining renal function for the first 24 hours after surgery.…”

“…3 The NSAID are inhibitors of the cyclooxygenase (COX) enzyme, which may be either reversible or irreversible. 6 Naproxen, diclofenac sodium, ketorolac tromethamine, and ibuprofen have been used before surgery in humans. 5 The COX-1 isoenzyme maintains normal physiologic function, whereas COX-2 is an inducible form and is activated by damaged and inflamed tissue.…”

Tepoxalin on renal function and liver enzymes in cats exposed to hypotension with isoflurane

“…Thus, it was possible to see if tepoxalin favored a possible worsening of renal ischemia, common in hypotension (POWER et al, 1992;PERKOWSKI & WETMORE, 2006).…”