Retrospective Study
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World J Gastroenterol. Oct 14, 2014; 20(38): 13956-13965
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13956
Characteristics and clinical outcome of nonsteroidal anti-inflammatory drug-induced acute hepato-nephrotoxicity among Chinese patients
Ya-Li Cao, Zhi-Gang Tian, Fang Wang, Wen-Ge Li, Dan-Ying Cheng, Yan-Fang Yang, Hong-Mei Gao
Ya-Li Cao, Wen-Ge Li, Yan-Fang Yang, Hong-Mei Gao, Department of Nephrology, China-Japan Friendship Hospital, Beijing 100029, China
Zhi-Gang Tian, Department of Surgery, Beijing Luhe Hospital, Beijing 101149, China
Fang Wang, Department of Gastroenterology, China-Japan Friendship Hospital, Beijing 100029, China
Dan-Ying Cheng, Department of Hepatology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
Author contributions: Cao YL designed the study, performed the majority of experiments and wrote the manuscript; Tian ZG performed the statistical analyses and was also involved in writing and editing the manuscript; Wang F and Cheng DY collected the liver tissue samples and did the hepatic histological study; Yang YF and Gao HM collected the kidney tissue samples and did the renal histological study; Li WG designed the study.
Supported by National Natural Science Foundation of China, No. 81200535; and China-Japan Friendship Hospital Youth Science and Technology Excellence Project, No. 2014-QNYC-A-01
Correspondence to: Wen-Ge Li, MD, PhD, Department of Nephrology, China-Japan Friendship Hospital, No. 2 Yinghua Street, Chaoyang District, Beijing 100029, China. yalicao050501@hotmail.com
Telephone: +86-10-84206118 Fax: +86-10-84206174
Received: March 31, 2014
Revised: June 8, 2014
Accepted: July 11, 2014
Published online: October 14, 2014
Processing time: 198 Days and 20.1 Hours
Abstract

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 NSAIDs-associated mere AKI, the risk factors of NSAIDs-induced 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 hepato-nephrotoxicity 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.

Keywords: Nonsteroidal anti-inflammatory drug; Hepato-nephrotoxicity; Acute interstitial nephritis; Acute hepatitis; Cholestasis

Core tip: This is the largest series to date demonstrating that nonsteroidal anti-inflammatory drugs are a common cause of acute combined hepato-nephrotoxicity in the Chinese population. The risk factors include age older than 60 years, alcohol use, positive hepatitis B virus markers, extracellular volume depletion and renin-angiotensin-aldosterone system inhibitor combined use. Acute tubulointerstitial disease and acute hepatitis were the major histological findings. Treatment for the patients comprised discontinuation of the implicated drugs and pulse methylprednisolone followed by oral steroids in some patients. Cyclophosphamide was added according to the histology. The prognosis was good with prompt diagnosis and treatment.