Urinary protein profiles in ketorolac-associated acute kidney injury in patients undergoing orthopedic day surgery

Urinary protein profiles in ketorolac-associated acute kidney injury in patients undergoing orthopedic day surgery

Parenteral administration of ketorolac is very effective in controlling postoperative pain for orthopedic surgery. Ketorolac can induce clinically relevant renal alterations in elderly patients, whereas its short course is considered safe for young adults with normal preoperative renal function. In...

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Bibliographic Details
Published in:International journal of nephrology and renovascular disease Vol. 10; pp. 269 - 274
Main Authors: Mariano, Filippo, Cogno, Chiara, Giaretta, Fulvia, Deambrosis, Ilaria, Pozza, Simona, Berardino, Maurizio, Massazza, Giuseppe, Biancone, Luigi
Format: Journal Article
Language:English
Published: New Zealand Dove Medical Press Limited 01-01-2017
Taylor & Francis Ltd
Dove Medical Press
Subjects:
Acute kidney failure
Analgesics
Anesthesiology
Bone surgery
Complications and side effects
Dosage and administration
Hospitals
Immunoglobulins
Immunology
Intensive care
Joint surgery
Ketorolac
Ketorolac - Acute kidney injury - Glomerular tubular index - Orthopedic day surgery
Kidneys
Laboratories
Ligaments
Nephrology
Nonsteroidal anti-inflammatory drugs
Original Research
Orthopedic surgery
Pain
Patients
Proteins
Science
Software
Ultrasonic imaging
Urine
Young adults
acute kidney injury
ketorolac
glomerular tubular index
orthopedic day surgery
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Summary:Parenteral administration of ketorolac is very effective in controlling postoperative pain for orthopedic surgery. Ketorolac can induce clinically relevant renal alterations in elderly patients, whereas its short course is considered safe for young adults with normal preoperative renal function. In this study, of a cohort of young adults undergoing elective orthopedic day surgery, we sought cases complicated by readmission due to acute kidney injury (AKI). Among 1397 young adults, aged 18-32 years who were admitted to undergo orthopedic day surgery from 2013 to 2015, four patients (0.29%, three males/one female) treated in postprocedure with ketorolac (from 60 to 90 mg/day for 1-2 days) were readmitted for suspected severe AKI. We evaluated functional outcome, urinary protein profiles and kidney biopsy (1 patient). After day surgery discharge, they experienced gastrointestinal disturbances, flank pain and fever. Readmitted on post-surgery days 3-4, they presented with oliguric AKI (creatinine range 158.4-466.4 µmol/L) and frank proteinuria (albumin range 2.1-6.0 g/L). Urine protein profiles demonstrated a nonselective glomerular proteinuria, with a significant 9.4-fold increase in glomerular/tubular index on day 6. Kidney biopsy on day 19 showed normal glomeruli and minimal tubular alterations and negative immunofluorescence. All patients recovered their renal function, and after 20 days proteinuria disappeared. AKI can ensue even in young adults who have undergone a short course of ketorolac, when they suffered from relative dehydration, abdominal disturbances, flank pain and oliguria after discharge. Urine findings were characterized by a marked nonselective glomerular proteinuria disappearing in 2-3 weeks.
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ISSN:1178-7058
1178-7058
DOI:10.2147/IJNRD.S137102