Feldman HI, Kinman JL, Berlin JA, Hennessy S, Kimmel SE,
Farrar J, et al
Ketorolac: the risk of acute renal failure
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1372 1996
Ketorolac (Toradol) is an injectable nonsteroidal anti-inflammatory
drug (NSAID) used for pain management. Cases of acute renal failure
have been reported associated with its use. NSAID's cause two different
forms of acute renal failure: hemodynamically-mediated and acute
interstitial nephritis .
These investigators performed a cohort study of the incidence of acute
renal failure during more than 10,000 courses of parenteral ketorolac
compared to a similar number of parenteral opioid courses. The overall
risk of acute renal failure, defined as a 50 % increase in serum
creatinine and an explicit physician diagnosis, was only 0.3 %. The
multivariate adjusted rate ratio for acute renal failure comparing
ketorolac to opioids was 1.02 for treatment of 5 days or shorter
duration and 3.5 for patients treated for more than 5 days. However,
the 95% confidence interval overlaps a rate ratio of 1.0 for both
groups. The investigators conclude that short term use of ketorolac
does not increase the likelihood of acute renal failure, but that
treatment with ketorolac for longer than 5 days may increase the risk of
acute renal failure.
Comment: Renal prostaglandins do not normally play a major role in
the
regulation of renal hemodynamics. However, the basal rate of
vasodilator prostaglandin synthesis is enhanced in states of effective
volume depletion, such as heart failure, hepatic cirrhosis, and true
volume depletion due to gastrointestinal or renal losses. In any of the
these settings, vasodilator prostaglandins act to preserve renal blood
flow and glomerular filtration rate. This is particularly important with
decreased effective volume in which the prostaglandins antagonize the
vasoconstrictor effects of angiotensin II and norepinephrine.
Because
of the very large size of the study population and the relatively few
numbers of patients at increased risk of NSAID induced renal failure,
this study may be too insensitive to determine the relative risk of
ketorolac induced acute renal failure.
(George R. Aronoff, M.D., University of Louisville, Kentucky)
To go back use the BACK button on your browser.
Otherwise click on the desired link to this article below:
Am Soc Nephrol
ARF etiology :
Other drug-associated ARF