Brater D C, Anderson S A, Brown-Cartwright D, Toto R D
Am J Kidney Dis. 1986 Nov;8(5):351-5. doi: 10.1016/s0272-6386(86)80110-x.
We have assessed the effects of acute and chronic administration of etodolac, ketoprofen, and indomethacin on renal function in patients with mild to moderate chronic renal insufficiency (CRI). We studied 18 normal volunteers and 24 patients with CRI due to hypertension and/or diabetes mellitus with creatinine clearances between 19 and 83 mL/min/1.73 m2. Clearance studies were performed with the first dose of nonsteroidal antiinflammatory drug (NSAID) to compare acute effects of the agent with a no-drug control. Subjects then received the NSAID for three to five days and, on the last day of study, underwent another clearance study to assess the effects of a single dose of NSAID superimposed on chronic dosing. With each dose of each NSAID, inulin and paraaminohippurate (PAH) clearances and fractional excretion of NA+ decreased. However, the baseline control collections after chronic dosing did not differ from the no-drug control periods. Hence, the decline in renal function with each dose is transient, and no overall adverse effect on renal function occurred with chronic dosing. In five patients with cirrhosis, we assessed the renal sparing effects of sulindac. After equilibration on a fixed sodium intake, they received a 200-mg dose of sulindac. In one patient, no adverse effect occurred; the remaining patients suffered declines in creatinine clearance of 29%, 87%, 37%, and 37%, respectively. This effect was transient and returned to control values six to eight hours after sulindac administration. At the time of maximal depression of renal function, serum concentrations of sulindac sulfide were comparable to those in subjects with normal hepatic function.(ABSTRACT TRUNCATED AT 250 WORDS)
我们评估了急性和慢性给予依托度酸、酮洛芬和吲哚美辛对轻至中度慢性肾功能不全（CRI）患者肾功能的影响。我们研究了18名正常志愿者以及24名因高血压和/或糖尿病导致CRI的患者，其肌酐清除率在19至83 mL/min/1.73 m²之间。在给予首剂非甾体抗炎药（NSAID）时进行清除率研究，以将该药物的急性效应与无药物对照进行比较。受试者随后接受NSAID治疗三至五天，并在研究的最后一天进行另一项清除率研究，以评估叠加在慢性给药上的单剂量NSAID的效应。每种NSAID的每次给药后，菊粉和对氨基马尿酸（PAH）清除率以及Na⁺分数排泄均降低。然而，慢性给药后的基线对照收集结果与无药物对照期并无差异。因此，每次给药后肾功能的下降是短暂的，慢性给药未对肾功能产生总体不良影响。在5名肝硬化患者中，我们评估了舒林酸的肾脏保护作用。在固定钠摄入量达到平衡后，他们接受了200 mg剂量的舒林酸。1名患者未出现不良反应；其余患者的肌酐清除率分别下降了29%、87%、37%和37%。这种效应是短暂的，在给予舒林酸六至八小时后恢复至对照值。在肾功能最大程度受抑制时，舒林酸硫化物的血清浓度与肝功能正常的受试者相当。（摘要截选至250词）
