title: Characteristics and clinical outcome of nonsteroidal anti-inflammatory drug-induced acute hepato-nephrotoxicity among Chinese patients.
abstract: OBJECTIVE
  To determine the clinicopathological characteristics of nonsteroidal anti-inflammatory drug (NSAID)-induced acute hepato-nephrotoxicity among Chinese patients.
  
  
  METHODS
  We conducted a retrospective chart review of patients using the International Classification of Diseases, Ninth Revision diagnosis code for acute kidney injury (AKI) (584.5 or 584.9) and for acute liver injury (ALI) (570.0 or 573.3) from January 2004 to December 2013. Medical records were reviewed to confirm the diagnosis of AKI and ALI and to quantify NSAID administration.
  
  
  RESULTS
  Seven of 59 patients (11.8%) were identified with acute hepato-nephrotoxicity induced by NSAIDs. Five patients (71.4%) received over the recommended NSAIDs dose. Compared with NSAIDs-associated mere AKI, the risk factors of NSAIDs-induced acute hepato-nephrotoxicity are age older than 60 years (57.1%), a high prevalence of alcohol use (71.4%) and positive hepatitis B virus (HBV) markers (85.7%). Compared with NSAIDs-associated mere ALI, the risk factors of NSAIDs-induced acute hepato-nephrotoxicity are age older than 60 years (57.1%), increased extracellular volume depletion (71.4%), and renin-angiotensin-aldosterone system (RAAS) inhibitor combined use (57.1%). Acute interstitial nephritis and acute tubulointerstitial disease were apparent in three out of six (42.9%) kidney biopsy patients, respectively. Acute hepatitis was found in four out of six (66.7%) liver biopsy patients. Overall complete recovery occurred in four patients within a mean of 118.25 ± 55.42 d.
  
  
  CONCLUSIONS
  The injury typically occurred after an overdose of NSAIDs. The risk factors include age older than 60 years, alcohol use, positive HBV markers, extracellular volume depletion and RAAS inhibitor combined use.
authors.affiliation: Ya-Li Cao, Wen-Ge Li, Yan-Fang Yang, Hong-Mei Gao, Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Ya-Li
authors.initials: YL
authors.lastname: Cao
authors.affiliation: Ya-Li Cao, Wen-Ge Li, Yan-Fang Yang, Hong-Mei Gao, Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Zhi-Gang
authors.initials: ZG
authors.lastname: Tian
authors.affiliation: Ya-Li Cao, Wen-Ge Li, Yan-Fang Yang, Hong-Mei Gao, Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Wang
authors.affiliation: Ya-Li Cao, Wen-Ge Li, Yan-Fang Yang, Hong-Mei Gao, Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Wen-Ge
authors.initials: WG
authors.lastname: Li
authors.affiliation: Ya-Li Cao, Wen-Ge Li, Yan-Fang Yang, Hong-Mei Gao, Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Dan-Ying
authors.initials: DY
authors.lastname: Cheng
authors.affiliation: Ya-Li Cao, Wen-Ge Li, Yan-Fang Yang, Hong-Mei Gao, Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Yan-Fang
authors.initials: YF
authors.lastname: Yang
authors.affiliation: Ya-Li Cao, Wen-Ge Li, Yan-Fang Yang, Hong-Mei Gao, Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China.
authors.forename: Hong-Mei
authors.initials: HM
authors.lastname: Gao
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000208:ethnology; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D044466:Asian People; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology* / Q000628:therapy; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D005260:Female; D006509:Hepatitis B / Q000208:ethnology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Acute hepatitis; Acute interstitial nephritis; Cholestasis; Hepato-nephrotoxicity; Nonsteroidal anti-inflammatory drug