[Neonatal chronic kidney failure associated with cyclo-oxygenase-2 inhibitors administered during pregnancy].
Non-steroidal anti-inflammatory drugs (NSAID) are used since years as tocolytic due to their capacity to inhibit cyclo-oxygenase (COX) expressed in uterus and fetal membranes, fundamental for labour initiation and maintenance. The use of nimesulide, a COX-2 selective NSAID, has been recently proposed due to its capacity to selectively inhibit the enzyme expressed in the myometrium and endometrium. A case of neonatal irreversible end stage renal failure after maternal assumption of nimesulide as tocolytic for 6 week is reported. Cesarean section at the 32nd week due to oligohydramnios gave birth to a baby girl of 2090 g, in good general conditions, without signs of respiratory distress and of visible abnormalities. From birth she displayed oligo-anuria which required dialytic substitutive therapy from the second day of life. At US scan both kidneys had normal diameters for gestational age slightly increased echogenicity and a reduced cortico-medullary differentiation. On the 20th day of life she had a surgical renal biopsy for the persistence of oligo-anuria, showing fetal glomeruli, without lymphocytic interstitial infiltrate, and normal tubuli without evidence of necrosis. She is now 16 months old and under automated peritoneal dialysis on a home dialysis program. The occurrence of chronic renal failure in strict relationship with maternal nimesulide assumption in this case is strongly suggestive for a pharmacological damage, either direct or mediated by renin angiotensin inhibition, and possibly modulated by genetic factors, likely to account for the different outcome of similarly treated patients. A cautious use of this drug as long term tocolytic should be recommended while waiting for ad hoc experimental and clinical evidences of safeness.
Peruzzi
L
L
Nefrologia e Dialisi, Ospedale Infantile Regina Margherita, Turin, Italy.
Gianoglio
B
B
Porcellini
G
G
Conti
G
G
Amore
A
A
Coppo
R
R
D000328:Adult; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000139:chemically induced*; D011247:Pregnancy; D013449:Sulfonamides / Q000009:adverse effects*; D015149:Tocolytic Agents / Q000009:adverse effects*
D016861:Cyclooxygenase Inhibitors; D013449:Sulfonamides; D015149:Tocolytic Agents; C012655:nimesulide