Effects of Misoprostol on Nonsteroidal Anti-Inflammatory Drug-Induced Renal Insufficiency in Patients with Stable Chronic Renal Failure: A Double-Blind, Crossover Study.
Nonsteroidal anti-inflammatory drugs (NSAIDs) have the ability to induce acute deterioration in renal function by inhibiting the production of vasodilatory prostaglandins, thereby disrupting intrarenal hemodynamic balance in patients with stable, mild, chronic renal failure. Misoprostol is a synthetic prostaglandin E-1 analog suitable for oral administration and is widely used in conjunction with NSAIDs to prevent another NSAID-induced complication, gastric ulcers. This investigation utilized a prospective double-blind, randomized, placebo-controlled crossover study designed to evaluate the possible renal protective effects of misoprostol on the renal function of patients with mild, stable, chronic renal failure, who intercurrently ingested ibuprofen 800 mg 8H or indomethacin 25 mg 8H. The mean baseline glomerular filtration rate of the patients who participated in the study was 53 ml/min (misoprostol)/55 ml/min (placebo), and 57 ml/min (misoprostol)/57 ml/min (placebo) in Study I (ibuprofen) and Study II (indomethacin), respectively. At this level of renal functional impairment, the use of the selected NSAIDs did not produce further significant impairment of renal function; hence, a renal protective role for misoprostol could not be demonstrated. To solve the question posed in our study, it will be necessary to conduct future investigations utilizing a recruitment GFR and serum creatinine values in the range of 35 ml/min and less and 2.0 mg/dl and greater, respectively.
Whelton
Andrew
A
Scott
Henry
H
Stout
Robert L.
RL