Question
1) Can Ocular NSAIDS (e.g ketorolac eye drops) cause AKI?
2) Can Topical NSAIDS (e.g diclofenac skin cream) cause AKI ?
1) Can Ocular NSAIDS (e.g ketorolac eye drops) cause AKI?
2) Can Topical NSAIDS (e.g diclofenac skin cream) cause AKI ?
There is one case reports which i could find of patient with ARF on HD coming off dialysis on stopping topical NSAIDs and one case report of biopsy showing FSGS with possible interstitial nephritis in a patient using topical NSAIDs with Cr and Proteinuria improving off topical NSAIDs.
ReplyDeleteI guess theoretically ocular ones can also cause it but, I didn't find anything reported.
Patients with ARF on HD come off dialysis all the time - my guess is that the recovery of renal function was unrelated to discontinuation of the topical NSAID.
ReplyDeleteI found one large study of adverse events with topical NSAIDs for arthritis in patients with multiple comorbidities - ARF was not even mentioned/reported as an adverse outcome.
In the absence of good data, my hunch is that systemic absorption is pretty low and unlikely to cause renal dysfuction - at least, not via the typical mechanism afferent arteriolar constriction.
Following application of ketorolac tromethamine 0.5% ophthalmic drops 3 times/day, the mean plasma concentrations of ketorolac are ~4% to 8% of the minimum concentration observed following oral doses of 10 mg 4 times/day.........So may not be clinically significant to cause renal effects.
ReplyDeleteDiclofenac topical gel has 6% to 10% systemic absorption. The prescribing information did not specifically mention about AKI but mention "No information is available from controlled
clinical studies regarding the use of Voltaren® Gel in patients with advanced renal disease. Therefore, treatment with Voltaren® Gel is not recommended in patients with advanced renal disease. If Voltaren® Gel therapy is initiated, close monitoring of the patient’s renal function is
advisable."