Acute nonoliguric renal failure in children associated with nonsteroidal antiinflammatory agents

Objective: Acute renal failure is commonly seen in adults after treatment with nonsteroidal antiinflammatory agents. This complication has rarely been reported in children. Design: Four consecutive patients admitted with acute nonoliguric renal failure associated with ingestion of nonsteroidal antiinflammatory agents. Setting: The emergency department and ward units at The Children's Hospital of Philadelphia. Patients: Four patients, ages 3.5 to 19 years. Interventions: Appropriate evaluations including measurement of serum creatinine concentrations in the emergency department and careful histories of drug ingestion. Main outcome measure: Rapid return to normal serum creatinine concentrations. Results: Four patients were admitted to The Children's Hospital of Philadelphia between May 1996 and June 1997 with a diagnosis of acute, nonoliguric renal failure following ingestion of nonsteroidal antiinflammatory agents. None of the patients had features of hemolytic uremic syndrome, systemic lupus, dehydration, obstructive uropathy or sickle cell disease. Each patient had ingested nonsteroidal antiinflammatory agents before the onset of acute renal failure, None had oliguria or anuria, dehydration, abnormal serum electrolyte concentrations, or evidence of glomerulonephritis. One patient also had a urinary tract infection that was treated with antibiotics. Another patient was treated with methylprednisolone and prednisone, None was biopsied, Three recovered completely. Conclusion: With the increasing use of over-the-counter nonsteroidal antiinflammatory agents, this association may become more prevalent.