Nabumetone-associated interstitial nephritis.
An 84-year-old woman was admitted to the hospital for progressive edema and decreased urine output. She had been taking nabumetone for 6 months, but had discontinued the agent 2 weeks before admission due to progressive edema. On admission she had 2-3+ pitting edema. Her serum electrolytes were sodium 122 mEq/L, potassium 5.9 mEq/L, chloride 93 mEq/L, and carbon dioxide 19 mEq/L. A urinalysis was significant for protein 3061 mg/dl, ketones 15 mg/dl, blood 2+, leukocytes 26-50/high-power field, and a protein:creatinine ratio 24.9. The serum creatinine and blood urea nitrogen concentrations were 2.7 mg/dl and 70 mg/dl, respectively. Throughout hospitalization the patient underwent aggressive diuresis. She developed congestive heart failure, and hemodialysis was initiated. A renal biopsy specimen on hospital day 9 showed tubular damage with minimal glomerular changes consistent with a diagnosis of nonsteroidal agent-induced nephropathy. On day 13, a 24-hour urine collection had a protein excretion of 3151 mg. Although the patient recovered from her renal failure (creatinine clearance 43 ml/min), the nephrotic syndrome persisted (13 g protein/day). The patient developed infectious complications and died on hospital day 32.
Blackwell
E
E
St. John Hospital and Medical Center, Detroit, Michigan, USA.
Loughlin
K
K
Dumler
F
F
Smythe
M
M
D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002074:Butanones / Q000009:adverse effects*; D004232:Diuretics / Q000627:therapeutic use; D004487:Edema / Q000139:chemically induced; D017809:Fatal Outcome; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D000077430:Nabumetone; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000188:drug therapy; D006435:Renal Dialysis
D000894:Anti-Inflammatory Agents, Non-Steroidal; D002074:Butanones; D004232:Diuretics; D000077430:Nabumetone