Nonsteroidal anti-inflammatory drugs are an important cause of acute kidney injury in children

Jason M. Misurac, Chad A. Knoderer, Jeffrey D. Leiser, Corina Nailescu, Amy C. Wilson, Sharon Andreoli

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Abstract

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 NSAIDassociated 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.

Original languageEnglish
JournalJournal of Pediatrics
Volume162
Issue number6
DOIs
StatePublished - Jun 2013

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Acute Kidney Injury
Anti-Inflammatory Agents
Pharmaceutical Preparations
International Classification of Diseases
Non-Steroidal Anti-Inflammatory Agents
Pediatrics
Interstitial Nephritis
Medical Records
Intensive Care Units
Dialysis
Length of Stay
Necrosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Nonsteroidal anti-inflammatory drugs are an important cause of acute kidney injury in children. / Misurac, Jason M.; Knoderer, Chad A.; Leiser, Jeffrey D.; Nailescu, Corina; Wilson, Amy C.; Andreoli, Sharon.

In: Journal of Pediatrics, Vol. 162, No. 6, 06.2013.

Research output: Contribution to journalArticle

Misurac, Jason M. ; Knoderer, Chad A. ; Leiser, Jeffrey D. ; Nailescu, Corina ; Wilson, Amy C. ; Andreoli, Sharon. / Nonsteroidal anti-inflammatory drugs are an important cause of acute kidney injury in children. In: Journal of Pediatrics. 2013 ; Vol. 162, No. 6.
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abstract = "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 NSAIDassociated 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.",
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N2 - 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 NSAIDassociated 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.

AB - 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 NSAIDassociated 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.

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