title: Effect of indomethacin and selective cyclooxygenase-2 inhibitors on proteinuria and renal function in patients with AA type renal amyloidosis.
abstract: OBJECTIVE
  Because the cardiovascular system (CVS) side-effects of cyclooxygenase-2 (COX-2) selective inhibitors have recently been questioned, we aimed to compare the renal and haemodynamic effects of cyclooxygenase selective (celecoxib and rofecoxib) and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) (indomethacin) in patients with renal amyloidosis secondary to rheumatological diseases who required anti-inflammatory agents and are taking maximum tolerable dose of angiotensin-converting enzyme inhibitors.
  
  
  METHODS
  The present study was performed on 11 patients with stable proteinuria who were diagnosed as AA amyloidosis secondary to rheumatological diseases confirmed by renal biopsies. The study had three consecutive stages (celecoxib 200 mg/day; indomethacin 100 mg/day; rofecoxib 25 mg/day.) Each was given for 4 weeks and a wash-out phase of 3 weeks was allowed between consecutive stages.
  
  
  RESULTS
  Although the decrease of proteinuria in the celecoxib period was higher than in the rofecoxib and indomethacin periods, the difference was not statistically significant. No statistically significant differences were found between serum urea, creatinine, creatinine clearance and urinary sodium excretion.
  
  
  CONCLUSIONS
  In this study, no differences were found between indomethacin and the two selective COX-2 inhibitors in respect to proteinuria and renal functions in 11 patients with renal amyloidosis secondary to rheumatological diseases with varying degrees of proteinuria. Routine doses of NSAIDs brought no additional benefit to the ACE inhibitor use in terms of proteinuria and renal functions. The use of selective COX-2 inhibitors should be limited to their anti-inflammatory and analgesic effects in this population.
authors.affiliation: Department of Nephrology, Uludag University Medical School, Bursa, Turkey. kserdar@uludag.edu.tr
authors.forename: Serdar
authors.initials: S
authors.lastname: Kahvecioglu
authors.forename: Kamil
authors.initials: K
authors.lastname: Dilek
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akdag
authors.forename: Mustafa
authors.initials: M
authors.lastname: Gullulu
authors.forename: Celalettin
authors.initials: C
authors.lastname: Demircan
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Ersoy
authors.forename: Mustafa
authors.initials: M
authors.lastname: Yurtkuran
mesh_terms: D000328:Adult; D000686:Amyloidosis / Q000145:classification / Q000150:complications* / Q000188:drug therapy / Q000652:urine; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects / Q000502:physiology; D007674:Kidney Diseases / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology* / Q000652:urine; D008297:Male; D011507:Proteinuria / Q000150:complications / Q000188:drug therapy* / Q000652:urine*
chemical_list: D052246:Cyclooxygenase 2 Inhibitors; D007213:Indomethacin