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Maternal ingestion of diclofenac leading to renal failure in newborns

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Abstract

Background

The use of non-steroidal anti-inflammatory drugs, such as indomethacin, ibuprofen, and nimesulide, during pregnancy has been reported to cause nephrotoxicity in the fetus. However, neonatal renal failure following antenatal exposure to diclofenac has not been reported in the literature. We report three cases of neonatal renal failure, including a pair of twins, following ingestion of diclofenac by the mother during pregnancy.

Case-Diagnosis/Treatment

Cases 1 and 2 involved a pair of twins born to a mother with oligohydramnios. The first twin had nonoliguric renal failure with incomplete recovery at day 17 of life. The second twin developed anuria and hyperkalemia on day 2 of life, for which peritoneal dialysis was initiated. After 20 days of peritoneal dialysis, the second twin remained oligo-anuric, developed peritonitis, and died. Case 3 involved a female infant born to a primigravida with severe oligohydramnios. The baby developed oliguria and renal failure after birth, which was managed conservatively. Creatinine normalized by day 15 of life and remained normal at 1 year of age. Ultrasonography in the first week of life showed that all three infants had normal-sized kidneys. Both mothers had been administered diclofenac during pregnancy.

Conclusions

In utero exposure to diclofenac may be associated with neonatal renal failure that may be transient or irreversible. We recommend that the use of diclofenac during pregnancy be avoided.

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Reference

  1. Cabrol D, Landesman R, Muller J, Uzan M, Sureau C, Saxena BB (1987) Treatment of polyhydramnios with prostaglandin synthetase inhibitor (indomethacin). Am J Obstet Gynecol 157:422–426

    PubMed  CAS  Google Scholar 

  2. Moise KJ Jr, Hutha JC, Sharif DS, Ou CN, Kirshon B, Wasserstrum N, Cano L (1988) Indomethacin in the treatment of premature labor. Effects on the fetal ductus arteriosus N Engl J Med 319:327–331

    Google Scholar 

  3. Sawdy RJ, Groom KM, Bennett PR (2004) Experience of the use of nimesulide, a cyclo-oxygenase-2 selective prostaglandin synthesis inhibitor, in the prevention of preterm labour in 44 high-risk cases. J Obstet Gynaecol 24:226–229

    Article  PubMed  CAS  Google Scholar 

  4. Benini D, Fanos V, Cuzzolin L, Tato L (2004) In utero exposure to nonsteroidal anti-inflammatory drugs: neonatal renal failure. Pediatr Nephrol 19:232–234

    Article  PubMed  Google Scholar 

  5. Kömhoff M, Grone HJ, Klein T, Seyberth HW, Nüsing RM (1997) Localization of cyclooxygenase-1 and −2 in adult and fetal human kidney: implication for renal function. Am J Physiol 272:F460–468

    PubMed  Google Scholar 

  6. Prévot A, Mosig D, Martini S, Guignard JP (2004) Nimesulide, a cyclooxygenase-2 preferential inhibitor, impairs renal function in the newborn rabbit. Pediatr Res 55:254–260

    Article  PubMed  Google Scholar 

  7. Zenker M, Klinge J, Krüger C, Singer H, Scharf J (1998) Severe pulmonary hypertension in a neonate caused by premature closure of ductus arteriosus following maternal treatment with diclofenac: a case report. J Perinat Med 26:231–234

    PubMed  CAS  Google Scholar 

  8. Kaplan BS, Restaino I, Raval DS, Gottlieb RP, Bernstein J (1994) Renal failure in the neonate associated with in utero exposure to non-steroidal anti-inflammatory agents. Pediatr Nephrol 8:700–704

    Article  PubMed  CAS  Google Scholar 

  9. Perruzzi L, Gianoglio B, Porcellini MG, Coppo R (1999) Neonatal end-stage renal failure associated with maternal ingestion of cyclo-oxygenase-type-1 selective inhibitor nimesulide as tocolytic. Lancet 354:1615

    Article  Google Scholar 

  10. Cataldi L, Leone R, Morelti U, De Mitri B, Fanos V, Ruggeri L, Sabatino G, Torcasio F, Zanardo V, Attardo G, Riccobene F, Martano C, Benini D, Cuzzolin L (2005) Potential risk factors for the development of acute renal failure in preterm newborn infants: a case control study. Arch Dis Child Fetal Neonatal Ed 90:F514–F519

    Article  PubMed  CAS  Google Scholar 

  11. Cuzzolin L, Fanos V, Pinna B, Di Marzio M, Perin M, Tramontozzi P, Tonetto P, Cataldi L (2006) Postnatal renal function in preterm newborns: a role of diseases, drugs and therapeutic interventions. Pediatr Nephrol 21:931–938

    Article  PubMed  Google Scholar 

  12. Ali US, Khubchandani S, Andankar P, Parekhji S, Dubhalish V, Padhye B (2006) Renal tubular dysgenesis associated with in utero exposure to nimesulide. Pediatr Nephrol 21:274–276

    Article  PubMed  Google Scholar 

  13. Landau D, Shelef I, Polacheck H, Marks K, Holcberg G (1999) Perinatal vasoconstrictive renal insufficiency associated with maternal nimesulide use. Am J Perinatol 16:441–444

    Article  PubMed  CAS  Google Scholar 

  14. Ali I, Ryan CA (2005) Transient renal failure in twins with maternal Cox 1 /Cox-2 use in pregnancy. Ir Med J 98:249–250

    PubMed  CAS  Google Scholar 

  15. Restaino I, Kaplan BS, Kaplan P, Rosenberg HK, Witzleben C, Roberts N (1991) Renal dysgenesis in a monozygotic twin: association with in utero exposure to indomethacin. Am J Med Genet 39:252–257

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Varsha Phadke.

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Phadke, V., Bhardwaj, S., Sahoo, B. et al. Maternal ingestion of diclofenac leading to renal failure in newborns. Pediatr Nephrol 27, 1033–1036 (2012). https://doi.org/10.1007/s00467-012-2114-z

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  • DOI: https://doi.org/10.1007/s00467-012-2114-z

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