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

Balestracci, Alejandro; Ezquer, Mauricio; Elmo, María Eugenia; Molini, Andrea; Thorel, Claudia; Torrents, Milagros; Toledo, Ismael

doi:10.1007/s00467-015-3105-7

Cited by 54 publications

(57 citation statements)

References 27 publications

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“…The children who developed acute renal injury tended to be younger (0.66 vs. 1.74 years; p < 0.001) and had more frequently taken ibuprofen (74 vs. 49%, p = 0.01). The authors emphasised that children under 6 months old have a higher risk of ibuprofen-related renal toxicity [8]. …”

Section: Safety and Tolerability Of Ibuprofenmentioning

confidence: 99%

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Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal

Martino

Chiarugi

Boner

et al. 2017

Drugs

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Ibuprofen is the most widely used non-steroidal anti-inflammatory drug (NSAID) for the treatment of inflammation, mild-to-moderate pain and fever in children, and is the only NSAID approved for use in children aged ≥3 months. Its efficacy and safety profile have led to its increasing use in paediatric care, even without medical prescription. However, an increase of suspected adverse reactions to ibuprofen has been noted in concomitance with the raised, often medically unsupervised, consumption of the drug. The purpose of this work was a critical review of the paediatric literature over the last 15 years on side effects and adverse events associated with ibuprofen, in order to highlight circumstances associated with higher risks and to promote safe and appropriate use of this drug. The literature from 2000 to date demonstrates that gastrointestinal events are rare, but (when they occur) include both upper and lower digestive tract lesions. Dehydration plays an important role in triggering renal damage, so ibuprofen should not be given to patients with diarrhoea and vomiting, with or without fever. Likewise, ibuprofen should never be administered to patients who are sensitive to it or to other NSAIDs. It is contraindicated in neonates and in children with wheezing and persistent asthma and/or during varicella. Most of the analysed studies reported adverse events when ibuprofen was being used for fever symptoms or flu-like syndrome. Ibuprofen should not be used as an antipyretic, except in rare cases. Ibuprofen remains the drug of first choice in the treatment of inflammatory pain in children.

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Section: Safety and Tolerability Of Ibuprofenmentioning

confidence: 99%

“…Emerging research has shown that the main side effects of ibuprofen involve the gastrointestinal system [7] and the kidneys [8], especially in feverish dehydrated individuals.…”

Section: Introductionmentioning

confidence: 99%

Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal

Martino

Chiarugi

Boner

et al. 2017

Drugs

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“…In addition, NSAID use is common in children with SCD [30], without evidence to support its benefit compared to other less nephrotoxic options [31]. Similarly, the use of NSAIDS in children hospitalized for various other reasons, including dehydration due to gastroenteritis, was associated with a significant increase in the incidence of AKI [32,33]. Therefore, it is not surprising that hemodynamic-mediated AKI secondary to NSAIDs, a potential modifiable risk factor, is relatively common in this population, especially as SCD patients are often at higher risk of volume depletion at the time of presentation due to their inherent reduced urine concentrating ability.…”

Section: Sickle Cell Nephropathy and Akimentioning

confidence: 99%

Acute kidney injury in children with sickle cell disease—compounding a chronic problem

2017

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In an article recently published in Pediatric Nephrology, Baddam and colleagues discuss the relatively underreported clinical problem of repeated episodes of acute kidney injury (AKI) in children with sickle cell disease (SCD). Their report is a cautionary note about the importance of repeated kidney injury on the background of underlying chronic kidney injury and its potential implications on long-term kidney outcome. In children and adults with SCD, this includes the effects of repeated vaso-occlusive crises and the management of these painful episodes with non-steroidal anti-inflammatory drugs. Here we review the scope of kidney involvement in SCD in children and discuss the potential short-and long-term consequences of AKI in children with SCD.

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“…The recommendation for NSAIDs during pain crisis is based on low quality evidence and does not provide any specific guidance on contraindications to NSAIDs [19]. The frequent administration of NSAIDs during prolonged pain crises likely places patients at increased risk for nephrotoxicity and AKI due to the underlying relative dehydration from hyposthenuria that SCD patients develop over time [21–23]. …”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury during a pediatric sickle cell vaso-occlusive pain crisis

et al. 2017

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Background Patients who develop sickle cell disease (SCD) nephropathy are at high risk for mortality. The pathophysiology of vaso-occlusive pain crisis may contribute to acute kidney injury (AKI). Non-steroidal anti-inflammatory drugs, known inducers of AKI, are used to treat pain crises. Multiple gaps exist in knowledge about the impact of AKI in SCD. Methods We conducted a two year retrospective review of AKI events in patients admitted for vaso-occlusive crisis. AKI was defined by an increase by ≥0.3 mg/dl or 50 % increase in serum creatinine from baseline. Laboratory values and ketorolac administration by days and dose (mg/kg) were identified from hospital records. Generalized mixed effects model for binary outcomes evaluated AKI based on laboratory variables and ketorolac administration. Generalized mixed Poisson effects model analyzed the association of AKI with hospital length of stay. Results Thirty three (17 %) of 197 admissions for vaso-occlusive pain crisis were associated with AKI. Fifty two percent of the cases presented to the Emergency Room (ER) with AKI. Every one unit drop in hemoglobin from baseline to admission increased the risk of AKI by 49 %. Among patients who received ketorolac for pain, both total days and doses of ketorolac were associated with AKI. Finally, patients with pain and AKI required longer hospitalizations than patients without AKI. Conclusion AKI during sickle cell pain crisis is common and may be an important modifiable risk factor for developing chronic kidney disease (CKD). Further studies are needed to determine the impact of nephrotoxic medications on progressive SCD nephropathy.

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

Abstract: 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.

Cited by 54 publications

References 27 publications

Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal

Working Towards an Appropriate Use of Ibuprofen in Children: An Evidence-Based Appraisal

Acute kidney injury in children with sickle cell disease—compounding a chronic problem

Acute kidney injury during a pediatric sickle cell vaso-occlusive pain crisis

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