Braden Gregory L, O'Shea Michael H, Mulhern Jeffrey G, Germain Michael J
Department of Medicine and Renal Division, Baystate Medical Center, Springfield, MA 01199, USA.
Nephrol Dial Transplant. 2004 May;19(5):1149-53. doi: 10.1093/ndt/gfg622. Epub 2004 Feb 19.
The renal effects of cyclooxygenase-2 (COX-2) inhibitors have been incompletely elucidated, and acute renal failure (ARF) due to COX-2 inhibitors has been reported.
In order to determine the causes of ARF and hyperkalaemia in five patients during COX-2 inhibitor therapy, we carefully analysed case studies of consecutive in-patients or out-patients referred to our Renal Division over a 6-month period for ARF and hyperkalaemia who had recently received COX-2 inhibitors.
ARF developed 2-3 weeks after COX-2 inhibitor therapy in five patients. The ARF was consistent with pre-renal azotaemia from renal hypoperfusion. Four patients were receiving the loop diuretic, furosemide. Four patients developed hyperkalaemia and decreased serum bicarbonate despite diuretic therapy, and one patient had changes in plasma renin activity and aldosterone levels consistent with reversible hyporeninaemic hypoaldosteronism. Renal failure was reversible after discontinuation of diuretics and COX-2 inhibitors.
COX-2 inhibitors may cause reversible ARF and hyperkalaemia in patients with oedematous conditions treated with low sodium diets and loop diuretics.
环氧化酶-2（COX-2）抑制剂对肾脏的影响尚未完全阐明，且已有关于COX-2抑制剂导致急性肾衰竭（ARF）的报道。
为确定5例患者在COX-2抑制剂治疗期间发生ARF和高钾血症的原因，我们仔细分析了在6个月内转诊至我院肾内科的连续住院或门诊患者的病例研究，这些患者近期接受了COX-2抑制剂治疗，出现了ARF和高钾血症。
5例患者在COX-2抑制剂治疗后2 - 3周出现ARF。该ARF与肾灌注不足导致的肾前性氮质血症相符。4例患者正在接受袢利尿剂呋塞米治疗。4例患者尽管接受了利尿剂治疗，但仍出现高钾血症且血清碳酸氢盐降低，1例患者血浆肾素活性和醛固酮水平发生变化，符合可逆性低肾素性低醛固酮血症。停用利尿剂和COX-2抑制剂后，肾衰竭可逆。
COX-2抑制剂可能在接受低钠饮食和袢利尿剂治疗的水肿患者中导致可逆性ARF和高钾血症。
