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Nephrotoxicity with cyclooxygenase 2 inhibitor use in children

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Abstract

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.

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Acknowledgements

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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Authors and Affiliations

  1. Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia

    Jeffery T. Fletcher, Anthony Scarman & Stephen I. Alexander

  2. Department of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia

    Jeffery T. Fletcher & Stephen I. Alexander

  3. Department of Histopathology, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia

    Nicole Graf

  4. Department of Nuclear Medicine, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia

    Hamda Saleh

  5. Centre for Kidney Research, Department of Nephrology, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia

    Stephen I. Alexander

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  1. Jeffery T. Fletcher
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  2. Nicole Graf
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  3. Anthony Scarman
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  4. Hamda Saleh
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Correspondence to Stephen I. Alexander.

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Fletcher, J.T., Graf, N., Scarman, A. et al. Nephrotoxicity with cyclooxygenase 2 inhibitor use in children. Pediatr Nephrol 21, 1893–1897 (2006). https://doi.org/10.1007/s00467-006-0252-x

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  • DOI: https://doi.org/10.1007/s00467-006-0252-x

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