NSAIDs problematic for children’s kidneys

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen given for pain or fever may cause acute kidney injury (AKI) in children, even when taken in the correct dose, according to research on the association between NSAIDs and development of chronic renal disease.

Investigators screened 1,015 hospitalized children aged 18 years and younger who had been diagnosed with AKI. They found 21 children for whom testing suggested NSAID-associated acute tubular necrosis and 6 with testing indicative of NSAID-associated acute interstitial nephritis, representing 2.7% of the cohort. Median age was 14.7 years; 4 children were aged younger than 5 years.

Twenty-one children had been using NSAIDs for fewer than 7 days, 2 had used NSAIDs between 7 days and 4 months, and 2 children used NSAIDs for an unspecified duration. Fifteen children for whom dosing information was available had been given NSAIDs within proper dosing limits, 2 received more than twice the recommended dose, and 3 received a dose less than 25% above the recommended upper limit.

None of the patients died or developed permanent kidney failure; however, 30% of the children displayed evidence of mild chronic kidney damage that persisted after their recovery. Most patients were adolescents, but patients aged younger than 5 years were more likely to have serious AKI and to need dialysis.

The researchers called their study the largest to date to associate NSAIDs with AKI in children. They suggest that the disease may be more severe in younger patients because of an increased susceptibility to toxic renal effects of NSAIDs, so using acetaminophen in some cases to reduce fever or relieve pain might be a better choice to help prevent acute kidney injury.