NSAIDs pose kidney risk in some children

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By Helen Albert, Senior medwireNews Reporter

A small but significant percentage of children develop acute kidney injury (AKI) after taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, show study findings published in the Journal of Pediatrics.

The researchers, led by Jason Misurac, from Indiana University School of Medicine in Indianapolis, USA, analyzed International Classification of Diseases, Ninth Revision screening data from 1015 children with AKI to assess the impact of NSAID use.

Of this group, 27 (2.7%) had clinical, laboratory, and radiographic signs of NSAID-associated injury, with 21 cases of acute tubular necrosis and six cases of acute interstitial nephritis.

Although the absolute numbers of these children are small, the damage caused can be considerable, notes the team. Indeed, at least seven sustained damage that was likely to be permanent.

"These cases, including some in which patients' kidney function will need to be monitored for years, as well as the cost of treatment, are quite significant, especially when you consider that alternatives are available and acute kidney injury from NSAIDs is avoidable," said Misurac in a press statement.

The mean age of the children with NSAID-induced AKI was 14.7 years, with only four patients younger than 5 years old at the time of injury. All four of these patients required dialysis, compared with none of the older children. They were also more likely to need intensive care unit admission than older children (75 vs 9%) and had a longer median stay in the hospital (10 vs 7 days).

The majority (75%) of the children with dosing data available (n=20) had received an NSAID dose within the recommended dosing limits for their age. The most common NSAID taken by the children was ibuprofen (67%), followed by naproxen (11%) and ketorolac (7%); the rest of the children took a combination of ibuprofen and naproxen or ketorolac.

"This study underscores the importance of understanding the natural history of NSAID-associated AKI, including the potential for development of chronic kidney disease," commented Misurac. "Providers should continue to provide careful NSAID education to parents and children."

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