Life-threatening renal failure caused by vasomotor nephropathy associated with nonsteroidal anti-inflammatory drugs.
The purpose of this study was to evaluate the prevalence of life-threatening renal failure (RF) caused by vasomotor nephropathy associated with nonsteroidal anti-inflammatory drug (NSAID) treatment (NSAID-RF) and risk factors for this renal impairment in an inception cohort of patients with recently diagnosed uremia treated by emergency hemodialysis in a prospective regional study. There are few published data on this phenomenon. Two hundred fifty-six patients (137 men, 119 women, mean age 68 years [22-95 years]) with acute uremia were treated with emergency hemodialysis in the intensive care unit over a period of 70 months. The patients were from an area of 231,000 inhabitants. Of the 256 patients, clinical data from a group of 79 patients with medical-type renal failure were analyzed in detail. The prevalence of NSAID-RF was 8%. This prevalence decreased to 4% when patients without any other medication affecting compensatory renal hemodynamics were considered. Moreover when nonpharmacological insults were not taken into account the prevalence decreased to only 1.6%. In 80% of the patients with NSAID-RF, nonpharmacological insults contributed to renal impairment. Both hypotension of cardiac etiology and dehydration/hypovolemia were present in 25% of the patients with this type of RF while urinary tract obstruction was seen in 1%. In 75% patients with NSAID-RF the underlying nephropathies were identified. NSAID-RF was not frequent. The population at greatest risk for renal functional alteration associated with NSAID therapy included patients with dehydration/hypovolemia, hypotension of cardiac etiology and those with pre-existing renal impairment, especially with vascular and analgesic nephropathy.
Horackova
M
M
Department of Medicine, 2nd Medical Faculty, Charles University, Prague, Czech Republic. Horackov@CZN.CZ
Charvat
J
J
Hasa
J
J
Forejt
J
J
Kvapil
M
M
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors; D014511:Uremia / Q000628:therapy; D014666:Vasomotor System / Q000503:physiopathology
D000894:Anti-Inflammatory Agents, Non-Steroidal