title: Nephrotoxicity with cyclooxygenase 2 inhibitor use in children.
abstract: The nephrotoxic potential of anti-inflammatory drugs alone and in compound preparations has been known for over fifty years. Nephrotoxicity associated with selective cyclooxygenase 2 (COX-2) inhibitor use is reported in adult patients but not in children. We present here the first report of reversible acute renal failure associated with the COX-2 inhibitor rofecoxib (Vioxx) in three children. Patient 1, an 18 month old girl with neonatal Bartter syndrome, developed acute renal failure with a peak creatinine of 1.9 mg/dl (164 micromol/l) and severe hyperkalemic metabolic acidosis. Patient 2, a 14 year old boy with a history of rheumatic fever, developed acute renal failure with a peak creatinine of 2.7 mg/dl (240 micromol/l). While patient 3, a healthy 14 year old girl, developed acute renal failure and tubulointerstitial nephritis confirmed on renal biopsy with a peak creatinine of 3.3 mg/dl (287 micromol/L). All children had been taking non-selective non-steroidal anti-inflammatory drugs (NSAID's) immediately prior to rofecoxib use. Renal function returned to normal within one week in all three patients and has remained normal at follow-up. This paper highlights the nephrotoxic risk of COX-2 inhibitor use in the pediatric population.
authors.affiliation: Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
authors.forename: Jeffery T
authors.initials: JT
authors.lastname: Fletcher
authors.forename: Nicole
authors.initials: N
authors.lastname: Graf
authors.forename: Anthony
authors.initials: A
authors.lastname: Scarman
authors.forename: Hamda
authors.initials: H
authors.lastname: Saleh
authors.forename: Stephen I
authors.initials: SI
authors.lastname: Alexander
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000473:pathology; D000293:Adolescent; D052246:Cyclooxygenase 2 Inhibitors / Q000633:toxicity*; D005260:Female; D006801:Humans; D007223:Infant; D007668:Kidney / Q000187:drug effects* / Q000473:pathology; D007783:Lactones / Q000633:toxicity*; D008297:Male; D013450:Sulfones / Q000633:toxicity*
chemical_list: D052246:Cyclooxygenase 2 Inhibitors; D007783:Lactones; D013450:Sulfones; C116926:rofecoxib