Nonsteroidal Anti-Inflammatory Drugs Are an Important Cause of Acute Kidney Injury in Children

Published:January 28, 2013DOI:https://doi.org/10.1016/j.jpeds.2012.11.069

      Objective

      To characterize nonsteroidal anti-inflammatory drug (NSAID)-associated acute kidney injury (AKI) in children.

      Study design

      We conducted a retrospective chart review of children diagnosed with AKI through the use of International Classification of Diseases, Ninth Revision diagnosis code 584.5 or 584.9 from January 1999 to June 2010. Medical records were reviewed to confirm the diagnosis of AKI and to quantify NSAID administration. Pediatric RIFLE criteria were used to codify AKI. Patients were not classified as having NSAID-associated AKI if they had a diagnosis explaining AKI or comorbid clinical conditions predisposing to AKI development.

      Results

      Patients (N = 1015) were identified through International Classification of Diseases, Ninth Revision screening. Twenty-one children had clinical, laboratory, and radiographic studies suggesting NSAID-associated acute tubular necrosis and 6 had findings suggesting NSAID-associated acute interstitial nephritis, representing 2.7% (27 of 1015) of the total cohort with AKI and 6.6% when excluding complex patients with multifactorial AKI. Children with NSAID-associated AKI had a median (range) age of 14.7 years (0.5-17.7 years); 4 patients (15%) were <5 years old. Fifteen of 20 children (75%) for whom dosing data were available received NSAIDs within recommended dosing limits. Patients <5 years old were more likely to require dialysis (100% vs 0%, P < .001), intensive care unit admission (75% vs 9%, P = .013), and a longer length of stay (median 10 vs 7 days, P = .037).

      Conclusions

      NSAID-associated AKI accounted for 2.7% of AKI in this pediatric population. AKI typically occurred after the administration of correctly dosed NSAIDs. Young children with NSAID-associated AKI may have increased disease severity.
      AIN ( Acute interstitial nephritis), AKI ( Acute kidney injury), ATN ( Acute tubular necrosis), eGFR ( Estimated glomerular filtration rate), GFR ( Glomerular filtration rate), IDMS ( Isotope dilution mass spectrometry), NSAID ( Nonsteroidal anti-inflammatory drug)
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