Ketoprofen-Induced Irreversible Renal Failure

P. Pazmiño, PhD, MD, NIH Center, Suite 101, 1701 N. Mesa & Schuster, El Paso, TX 79902 (USA) Dear Sir, Ketoprofen (Orudis®, Wyeth) is a new nonsteroidal anti-inflammatory agent with analgesic properties which was recently released for clinical use in the USA. We report here a case of irreversible renal failure after treatment for 10 days with ketoprofen. Clinicians should be aware of this potential nephrotoxicity and use caution in its administration, especially in patients with preexistent renal disease, hypertension or compromised intravascu-lar volume status. Case Report An 84-year-old white male was admitted to the hospital for evaluation of nausea, vomiting, azotemia, and hyperkalemia. There was no history of hematuria, rash, fever, or urinary complaints. As an outpatient, he was on treatment for 3 years with Dyazide® (hydrochlorothiazide 25 mg, triamterene 50 mg) p.o. b.i.d., multi-vitamins (1 p.o. q.d.), and dipyridamole (75 mg p.o. b.i.d.). Ten days prior to admission, he was given ketoprofen (75 mg p.o. t.i.d.), because of arthritic complaints, and a week later the dose was decreased to 75 mg/day for 3 additional days. Because of flu-like symptoms, Symmetrel® (amantadine 100 mg p.o. b.i.d.) was added and laboratory tests were obtained by the referring physician that eventually prompted hospitalization. On admission all medications were discontinued. The blood pressure was 136/80 mm Hg, the temperature was 36 °C, the pulse was 86/min, and the respiratory rate was 18/min. The remainder of the physical exam was noncontributory except for mild prostatic hypertrophy and dryness of the mucosae. The urinalysis showed a pH of 5, a specific gravity of 1.014,8–9 WBCs/high-power field and no casts or bacteria. A Hanzel stain of the urine sediment showed 5% eosinophils. The hematocrit was 32.8%, WBC count was 14,800/ mm3 with 47% segmented neutrophils, 8% bands, 23% lympocytes, 7% monocytes, 9% eosinophils, and 6% metamyelocytes. The potassium was 6.3 mEq/1 (6.3 mmol/l), chloride 112 mEq/1 (112 mmol/l), CO2 9.7 mEq/1 (9.7 mmol/l), glucose 94 mg/dl (5.05 mmol/l), BUN Ill mg/dl (39.63 mmol/l), and creatinine 12.4 mg/dl (1096 μmol/l). Three months earlier, on a previous admission due to pneumonia, the BUN was 31 mg/dl (11.06 mmol/l), creatinine was 1.7 mg/dl (150.28 μmol/l). An ultrasound of the kidney did not reveal hydronephrosis. A 24-hour urine collection showed a creatinine clearance of 3 ml/ min/1.73 m2 and 897 mg of protein. The following tests were normal or negative: urine toxicology and heavy-metal screen, urine culture, electrocardiogram, chest X-ray, hepatitis profile, CPK, LDH, im-munoglobulin E, and SGOT. A repeat creatinine