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Pediatric Nephrology

, Volume 30, Issue 10, pp 1873–1878 | Cite as

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

  • Alejandro Balestracci
  • Mauricio Ezquer
  • María Eugenia Elmo
  • Andrea Molini
  • Claudia Thorel
  • Milagros Torrents
  • Ismael Toledo
Original Article

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.

Keywords

Non-steroidal anti-inflammatory drugs Diarrhea Vomiting Volume depletion Acute renal failure 

References

  1. 1.
    Section on Clinical Pharmacology and Therapeutics, Committee on Drugs, Sullivan JE, Farrar HC (2011) Fever and antipyretic use in children. Pediatrics 127(3):580–587CrossRefGoogle Scholar
  2. 2.
    Lesko SM, Mitchell AA (1999) The safety of acetaminophen and ibuprofen among children younger than two years old. Pediatrics 104(4):e39CrossRefPubMedGoogle Scholar
  3. 3.
    Vernacchio L, Kelly JP, Kaufman DW, Mitchell AA (2009) Medication use among children <12 years of age in the United States: results from the Slone Survey. Pediatrics 124(2):446–454CrossRefPubMedGoogle Scholar
  4. 4.
    Leroy S, Mosca A, Landre-Peigne C, Cosson MA, Pons G (2007) Ibuprofen in childhood: evidence-based review of efficacy and safety. Arch Pediatr 14(5):477–484CrossRefPubMedGoogle Scholar
  5. 5.
    Misurac JM, Knoderer CA, Leiser JD, Nailescu C, Wilson AC, Andreoli SP (2013) Nonsteroidal anti-inflammatory drugs are an important cause of acute kidney injury in children. J Pediatr 162(6):1153–1159CrossRefPubMedGoogle Scholar
  6. 6.
    John CM, Shukla R, Jones CA (2007) Using NSAID in volume depleted children can precipitate acute renal failure. Arch Dis Child 92(6):524–526PubMedCentralCrossRefPubMedGoogle Scholar
  7. 7.
    Krause I, Cleper R, Eisenstein B, Davidovits M (2005) Acute renal failure, associated with non-steroidal anti-inflammatory drugs in healthy children. Pediatr Nephrol 20(9):1295–1298CrossRefPubMedGoogle Scholar
  8. 8.
    Ulinski T, Guigonis V, Dunan O, Bensman A (2004) Acute renal failure after treatment with non-steroidal anti-inflammatory drugs. Eur J Pediatr 163(3):148–150CrossRefPubMedGoogle Scholar
  9. 9.
    Friedman JN, Goldman RD, Srivastava R, Parkin PC (2004) Development of a clinical dehydration scale for use in children between 1 and 36 months of age. J Pediatr 145(2):201–207CrossRefPubMedGoogle Scholar
  10. 10.
    Colletti JE, Brown KM, Sharieff GQ, Barata IA, Ishimine P, ACEP Pediatric Emergency Medicine Committee (2010) The management of children with gastroenteritis and dehydration in the emergency department. J Emerg Med 38(5):686–698CrossRefPubMedGoogle Scholar
  11. 11.
    Kovesi TA, Swartz R, MacDonald N (1998) Transient renal failure due to simultaneous ibuprofen and aminoglycoside therapy in children with cystic fibrosis. N Engl J Med 338(1):65–66CrossRefPubMedGoogle Scholar
  12. 12.
    Ashraf E, Ford L, Geetha R, Cooper S (1999) Safety profile of ibuprofen suspension in young children. Inflammopharmacology 7(3):219–225CrossRefPubMedGoogle Scholar
  13. 13.
    Bernztein R, Drake I, Elordi S (2008) Variability in the management of bronchiolitis in the public first level of attention in Argentina. Arch Argent Pediatr 106(3):205–211PubMedGoogle Scholar
  14. 14.
    Andreoli SP (2009) Acute kidney injury in children. Pediatr Nephrol 24(2):253–263PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    World Health Organization (2005) The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th revison (2005) World Health Organization, Geneva. Available at: http://www.who.int/child-adolescenthealth/Emergencies/Diarrhoea_guidelines.pdf
  16. 16.
    Gorelick MH, Shaw KN, Murphy KO (1997) Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics 99(5):E6CrossRefPubMedGoogle Scholar
  17. 17.
    American Academy of Pediatrics, Provisional Committee on Quality Improvement, Subcommittee on Acute Gastroenteritis (1996) Practice parameter: the management of acute gastroenteritis in young children. Pediatrics 97:424–435Google Scholar
  18. 18.
    Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263PubMedGoogle Scholar
  19. 19.
    Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL (2007) Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 71:1028–1035CrossRefPubMedGoogle Scholar
  20. 20.
    Heilbron DC, Holliday MA, al-Dahwi A, Kogan BA (1991) Expressing glomerular filtration rate in children. Pediatr Nephrol 5(1):5–11CrossRefPubMedGoogle Scholar
  21. 21.
    Hall AH, Smolinske SC, Kulig KW, Rumack BH (1998) Ibuprofen overdose—a prospective study. West J Med 148(6):653–656Google Scholar
  22. 22.
    Levine M, Khurana A, Ruha AM (2010) Polyuria, acidosis, and coma following massive ibuprofen ingestion. J Med Toxicol 6(3):315–317PubMedCentralCrossRefPubMedGoogle Scholar
  23. 23.
    Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Acute Kidney Injury Network (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11(2):R31PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Imani PD, Odiit A, Hingorani SR, Weiss NS, Eddy AA (2013) Acute kidney injury and its association with in-hospital mortality among children with acute infections. Pediatr Nephrol 28(11):2199–2206CrossRefPubMedGoogle Scholar
  25. 25.
    Moghtaderi M, Yaghmaii B, Allahwerdi B, Gorgi M, Javadilarijani F, Malekzadeh I, Sadrosadat T, Nejad J (2014) Acute kidney injury in children with acute gastroenteritis. J Pediatr Nephrol 2(2):76–78Google Scholar
  26. 26.
    Lesko SM, Mitchell AA (1997) Renal function after short-term ibuprofen use in infants and children. Pediatrics 100(6):954–957CrossRefPubMedGoogle Scholar
  27. 27.
    Patzer L (2008) Nephrotoxicity as a cause of acute kidney injury in children. Pediatr Nephrol 23(12):2159–2173CrossRefPubMedGoogle Scholar
  28. 28.
    Moghal NE, Hegde S, Eastham KM (2004) Ibuprofen and acute renal failure in a toddler. Arch Dis Child 89(3):276–277PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Vachvanichsanong P, Dissaneewate P, Lim A, McNeil E (2006) Childhood acute renal failure: 22-year experience in a university hospital in southern Thailand. Pediatrics 118:e786–e791CrossRefPubMedGoogle Scholar

Copyright information

© IPNA 2015

Authors and Affiliations

  • Alejandro Balestracci
    • 1
  • Mauricio Ezquer
    • 2
  • María Eugenia Elmo
    • 2
  • Andrea Molini
    • 2
  • Claudia Thorel
    • 2
  • Milagros Torrents
    • 2
  • Ismael Toledo
    • 1
  1. 1.Nephrology UnitHospital General de Niños Pedro de ElizaldeCiudad Autónoma de Buenos AiresArgentina
  2. 2.Department of PediatricsHospital General de Niños Pedro de ElizaldeCiudad Autónoma de Buenos AiresArgentina

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