title: Ibuprofen-associated acute kidney injury in dehydrated children with acute gastroenteritis.
abstract: BACKGROUND
  Non-steroidal anti-inflammatory drugs (NSAIDs) induce acute kidney injury (AKI) in volume-depleted patients; however the prevalence of this complication is likely underestimated. We assessed the impact of ibuprofen exposure on renal function among dehydrated children with acute gastroenteritis (AGE) to further characterize NSAID-associated AKI.
  
  
  METHODS
  Over a 1-year period dehydrated children with AGE (n = 105) were prospectively enrolled and grouped as cases, presenting with AKI (n = 46) or controls, not presenting with AKI (n = 59). AKI was defined by pediatric RIFLE (pRIFLE) criteria.
  
  
  RESULTS
  Among the children enrolled in the study, AKI prevalence was 44 %, and 34 (54 %) of the 63 patients who received ibuprofen developed renal impairment. Relative to the controls, children presenting with AKI were younger (median age 0.66 vs. 1.74 years; p < 0.001) and received ibuprofen more frequently (74 vs. 49 %, p = 0.01). After adjusting for the degree of dehydration, ibuprofen exposure remained an independent risk factor for AKI (p < 0.001, odds ratio 2.47, 95 % confidence interval 1.78-3.42). According to the pRIFLE criteria, 17 patients were at the 'risk' stage of AKI severity, 24 were at the 'injury' stage, and five were at the 'failure' stage; none required dialysis. Distribution of patients within categories was similar regardless of ibuprofen exposure. All cases fulled recovered from AKI.
  
  
  CONCLUSIONS
  Ibuprofen-associated AKI was 54 % in our cohort of dehydrated children with AGE. Drug exposure increased the risk for developing AKI by more than twofold, independent of the magnitude of the dehydration.
authors.affiliation: Nephrology Unit, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, 1270, Ciudad Autónoma de Buenos Aires, Argentina, abalestracci@yahoo.com.ar.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Balestracci
authors.forename: Mauricio
authors.initials: M
authors.lastname: Ezquer
authors.forename: María Eugenia
authors.initials: ME
authors.lastname: Elmo
authors.forename: Andrea
authors.initials: A
authors.lastname: Molini
authors.forename: Claudia
authors.initials: C
authors.lastname: Thorel
authors.forename: Milagros
authors.initials: M
authors.lastname: Torrents
authors.forename: Ismael
authors.initials: I
authors.lastname: Toledo
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000150:complications / Q000453:epidemiology; D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use; D001118:Argentina / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003681:Dehydration / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D005759:Gastroenteritis / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007052:Ibuprofen / Q000009:adverse effects* / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D007052:Ibuprofen