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Ibuprofen-associated acute kidney injury in dehydrated children with acute gastroenteritis

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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.

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Authors and Affiliations

  1. Nephrology Unit, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, 1270, Ciudad Autónoma de Buenos Aires, Argentina

    Alejandro Balestracci & Ismael Toledo

  2. Department of Pediatrics, Hospital General de Niños Pedro de Elizalde, Montes de Oca 40, 1270, Ciudad Autónoma de Buenos Aires, Argentina

    Mauricio Ezquer, María Eugenia Elmo, Andrea Molini, Claudia Thorel & Milagros Torrents

Authors
  1. Alejandro Balestracci
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  2. Mauricio Ezquer
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  3. María Eugenia Elmo
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  4. Andrea Molini
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  5. Claudia Thorel
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  6. Milagros Torrents
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  7. Ismael Toledo
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Correspondence to Alejandro Balestracci.

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Balestracci, A., Ezquer, M., Elmo, M.E. et al. Ibuprofen-associated acute kidney injury in dehydrated children with acute gastroenteritis. Pediatr Nephrol 30, 1873–1878 (2015). https://doi.org/10.1007/s00467-015-3105-7

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  • DOI: https://doi.org/10.1007/s00467-015-3105-7

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