Frågedatum: 1997-07-21
RELIS database 1997; id.nr. 14104, DRUGLINE
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What is the clinical picture of renal damage associated with NSAID intoxication? Is corticosteriod



Fråga: What is the clinical picture of renal damage associated with NSAID intoxication? Is corticosteriod treatment of any benefit? Two men, 23 and 26 years of age, were admitted to hospital approximately three days after ingesting a mixture of alcohol, paracetamol and naproxen. They had increasing serum creatinine levels (711 and 440 micromolar, respectively, after three days in hospital) and proteinuria.

Sammanfattning: Previously healthy patients with NSAID intoxication may present with nausea, lumbar pain, oliguria, proteinuria and hematuria. Renal side-effects are commonly described in connection with both therapeutic use and overdosing of NSAID. The combination of alcohol, paracetamol and NSAID in the present two cases may further increase the risk of renal and also hepatic toxicity.

Svar: A thorough literature search, including Medline, Drugline and common pharmacological handbooks, has been performed. Renal side-effects associated with the use of non-steroidal antiinflammatory drugs (NSAID), in predisposed individuals with heart- or kidney disease as well as in previously healthy individuals, exposed to normal or high doses, are well described in the literature. Nausea, lumbar pain, oliguria, proteinuria and hematuria seems to be common signs of NSAID intoxication in previously healthy individuals. Increases of serum creatinine to 190-930 micromolar have been described (1). Prostaglandin synthesis inhibition, even from moderate NSAID doses, leads to enhanced renal vasocontriction, which, in predisposed individuals, may lead to renal insufficiency, oliguria and sometimes acute tubular necrosis (2-3). Interstitial nephritis, hyperkalemia and anaphylaxis are other renal side-effects that have been connected to the use of NSAID (2, 4). Corticosteroids have been suggested to be of benefit in the resolution of proteinuria and renal failure asociated with interstitial nephritis in some patients (2). Fortunately, renal side-effects from NSAID seems almost always to be reversible, even in severe or complicated cases.

Renal damage, with or without signs of liver damage, can also be seen from paracetamol overdosing (5-7). Concommitant intake of possibly home-made alcoholic beverages of unknown amount and quality does further complicate the picture in the two present cases.

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