INTRODUCTION: Nonsteroidal antiinflammatory drugs (NSAIDs) are ever increasing in popularity in hospital medicine and general practice and are readily available over-the-counter.

OBJECTIVE: Our goal was to illustrate the need to be aware of the effect of NSAIDs on dehydrated patients.

PATHOGENESIS: The risk of renal toxicity is increased in situations in which there is a stimulation of the renin-angiotensin system such as volume depletion. In these conditions, circulating vasoconstrictors are released, maintaining vascular resistance and blood pressure at the potential expense of regional organ blood flow. To maintain renal blood flow, counter-regulatory renal prostaglandins are released that counteract vasoconstrictors and normalize renal blood flow. NSAIDs blunt this counter-regulatory response and intensify the renal vasoconstriction, which leads to acute renal failure. In Table 1 we report 4 children with mild dehydration who developed acute renal failure after the use of therapeutic doses of NSAIDs in a children's hospital.

CONCLUSIONS: We recommend that NSAIDs should be avoided in children with actual or potential intravascular volume depletion. Although we have not proven cause and effect, additional research is needed to define the true risk of the potential renal complications of using NSAIDs in patients who are at risk of dehydration.

NOTE: The cases of the 4 children described in this report have been published elsewhere (John CM, Shukla R, Jones CA. Using NSAID in volume depleted children can precipitate acute renal failure. Arch Dis Child. 2007;92:524–526).

TABLE 1.

Acute Renal Failure in 4 Children After Use of NSAIDs

Patient No.
1234
Age, y 13 14 13 
Gender Male Male Male Female 
Underlying pathology Craniopharyngioma diabetes insipidus Juvenile idiopathic arthritis; fasted for surgery Juvenile idiopathic arthritis with vomiting Relapse of Crohn disease 
NSAID Diclofenac sodium Indomethacin diclofenac sodium Diclofenac sodium Diclofenac sodium 
Highest urea level, mmol urea/L 10.7 12.9 10.7 22 
Highest creatinine level, μmol/L 226 146 376 629 
Normalization, d Permanent impairment 
Patient No.
1234
Age, y 13 14 13 
Gender Male Male Male Female 
Underlying pathology Craniopharyngioma diabetes insipidus Juvenile idiopathic arthritis; fasted for surgery Juvenile idiopathic arthritis with vomiting Relapse of Crohn disease 
NSAID Diclofenac sodium Indomethacin diclofenac sodium Diclofenac sodium Diclofenac sodium 
Highest urea level, mmol urea/L 10.7 12.9 10.7 22 
Highest creatinine level, μmol/L 226 146 376 629 
Normalization, d Permanent impairment 

You do not currently have access to this content.