Pediatric Nephrology

, Volume 21, Issue 12, pp 1893–1897 | Cite as

Nephrotoxicity with cyclooxygenase 2 inhibitor use in children

  • Jeffery T. Fletcher
  • Nicole Graf
  • Anthony Scarman
  • Hamda Saleh
  • Stephen I. AlexanderEmail author
Brief Report


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 μmol/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 µmol/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 µmol/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.


Analgesic nephropathy ARF COX-2 inhibitors Kidney Pediatrics 



JF is supported by the NHMRC Medical Postgraduate Research Scholarship and received previous support by The Children’s Hospital at Westmead Clinical Fellowship.


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Copyright information

© IPNA 2006

Authors and Affiliations

  • Jeffery T. Fletcher
    • 1
    • 2
  • Nicole Graf
    • 3
  • Anthony Scarman
    • 1
  • Hamda Saleh
    • 4
  • Stephen I. Alexander
    • 1
    • 2
    • 5
    Email author
  1. 1.Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadAustralia
  2. 2.Department of Paediatrics and Child HealthUniversity of SydneySydneyAustralia
  3. 3.Department of HistopathologyThe Children’s Hospital at WestmeadWestmeadAustralia
  4. 4.Department of Nuclear MedicineThe Children’s Hospital at WestmeadWestmeadAustralia
  5. 5.Centre for Kidney Research, Department of NephrologyThe Children’s Hospital at WestmeadWestmeadAustralia

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