Blackwell E, Loughlin K, Dumler F, Smythe M
Nabumetone-associated interstitial nephritis
Pharmacotherapy
(Oct) 15:669-672 1995
Blackwell and colleagues report an
85-year-old woman who developed nephrotic
syndrome and acute renal failure after taking
nabumetone for six months. A renal biopsy
showed tubular damage and minimal glomerular
change consistent with a nonsteroidal
anti-inflammatory drug induced nephritis. She died
of infection during the hospitalization.
Comment:: Nonsteroidal anti-inflammatory drugs
(NSAIDs) may cause acute renal failure from
unopposed vasoconstriction or acute interstitial
nephritis. NSAID induced hemodynamic renal
failure is characterized by sudden oliguria, often
with decreased fractional excretion of sodium,
occurring in patients with decreased effective
circulating fluid volume or preexisting renal
disease. Allergic interstitial nephritis from NSAIDs
may occur at any time during therapy with the drugs
and may present as renal failure with or without the
nephrotic syndrome. Although chronic renal failure
has been reported, both renal syndromes usually
resolve when treatment with the NSAID is
discontinued.
This case represents one of the first cases of
acute renal failure reported with nabumetone. As
with the use of other NSAIDs, patients treated with
nabumetone should have their renal function
measured soon after initiation of therapy and
periodically thereafter. Because the occurrence of
interstitial nephritis cannot be predicted, all patients
receiving NSAIDs should be cautioned about the
development of edema which could be a sign of the
nephrotic syndrome. Patients should be warned
about the potential toxicity of the drugs.
(Aronoff)
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ARF etiology :
Acute interstitial nephritis/NSAID
ARF etiology :
Other drug-associated ARF