Perinatal vasoconstrictive renal insufficiency associated with maternal nimesulide use.
A full-term newborn developed oliguric renal failure at 24 hr of life, which persisted for several days. Her mother ingested therapeutic doses of nimesulide, a non-steroidal anti-inflammatory (cyclo-oxygenase-2 inhibitor) drug, during the last 2 weeks of pregnancy. She was found at delivery to have developed oligohydramnion, esophagitis, and a bleeding peptic ulcer. The infant's fractional excretion of sodium was very low (0.5%) pointing for a severe vasoconstrictive mechanism involved. Renal sonogram showed hyperechogenic medullary papillae, which resolved during convalescence. This case emphasizes the importance of renal prostagandins in the control of vascular tone and sodium homeostasis. This is the first report of an adverse effect of fetal renal circulation by maternal ingestion of nimesulide.
Landau
D
D
Department of Pediatrics, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel.
Shelef
I
I
Polacheck
H
H
Marks
K
K
Holcberg
G
G
D058186:Acute Kidney Injury / Q000151:congenital* / Q000000981:diagnostic imaging / Q000209:etiology*; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D018771:Arthralgia / Q000188:drug therapy; D003371:Cough / Q000188:drug therapy; D005260:Female; D005334:Fever / Q000188:drug therapy; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007677:Kidney Function Tests; D008431:Maternal-Fetal Exchange; D009846:Oliguria / Q000139:chemically induced* / Q000503:physiopathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011297:Prenatal Exposure Delayed Effects; D012075:Remission, Spontaneous; D013449:Sulfonamides / Q000009:adverse effects* / Q000627:therapeutic use; D014463:Ultrasonography
D000894:Anti-Inflammatory Agents, Non-Steroidal; D013449:Sulfonamides; C012655:nimesulide