Characteristics and clinical outcome of nonsteroidal anti-inflammatory drug-induced acute hepato-nephrotoxicity among Chinese patients

• Published in: World journal of gastroenterology : WJG Vol. 20; no. 38; pp. 13956 - 13965
• Main Authors: Cao, Ya-Li, Tian, Zhi-Gang, Wang, Fang, Li, Wen-Ge, Cheng, Dan-Ying, Yang, Yan-Fang, Gao, Hong-Mei
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 14.10.2014
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - diagnosis; Acute Kidney Injury - ethnology; Acute Kidney Injury - therapy; Adolescent; Adult; Age Factors; Aged; Alcohol Drinking - adverse effects; Alcohol Drinking - ethnology; Angiotensin II Type 1 Receptor Blockers - adverse effects; Angiotensin-Converting Enzyme Inhibitors - adverse effects; anti-inflammatory; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Asian Continental Ancestry Group; Biopsy; Chemical and Drug Induced Liver Injury - diagnosis; Chemical and Drug Induced Liver Injury - ethnology; Chemical and Drug Induced Liver Injury - etiology; Chemical and Drug Induced Liver Injury - therapy; Child, Preschool; China - epidemiology; drug; Female; Hep-ato-nephro; Hepatitis B - ethnology; Humans; Male; Middle Aged; Nonsteroidal; Predictive Value of Tests; Retrospective Studies; Retrospective Study; Risk Factors; Treatment Outcome; Young Adult; Acute hepatitis; Hepato-nephrotoxicity; Acute interstitial nephritis; Cholestasis; Nonsteroidal anti-inflammatory drug
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i38.13956

AIM:To determine the clinicopathological characteristics of nonsteroidal anti-inflammatory drug(NSAID)-induced acute hepato-nephrotoxicity among Chinese patients.METHODS:We conducted a retrospective chart review of patients using the International Classification of Diseases,Ninth Revision diagnosis code for acute kidney injury(AKI)(584.5 or 584.9)and for acute liver injury(ALI)(570.0 or 573.3)from January 2004 to December 2013.Medical records were reviewed to confirm the diagnosis of AKI and ALI and to quantify NSAID administration.RESULTS:Seven of 59 patients(11.8%)were identified with acute hepato-nephrotoxicity induced by NSAIDs.Five patients(71.4%)received over the recommended NSAIDs dose.Compared with NSAIDsassociated mere AKI,the risk factors of NSAIDsinduced acute hepato-nephrotoxicity are age older than 60 years(57.1%),a high prevalence of alcohol use(71.4%)and positive hepatitis B virus(HBV)markers(85.7%).Compared with NSAIDs-associated mere ALI,the risk factors of NSAIDs-induced acute hepatonephrotoxicity are age older than 60 years(57.1%),increased extracellular volume depletion(71.4%),and renin-angiotensin-aldosterone system(RAAS)inhibitor combined use(57.1%).Acute interstitial nephritis and acute tubulointerstitial disease were apparent in three out of six(42.9%)kidney biopsy patients,respectively.Acute hepatitis was found in four out of six(66.7%)liver biopsy patients.Overall complete recovery occurred in four patients within a mean of 118.25±55.42 d.CONCLUSION:The injury typically occurred after an overdose of NSAIDs.The risk factors include age older than 60 years,alcohol use,positive HBV markers,extracellular volume depletion and RAAS inhibitor combined use.