Abstract

Non-steroidal anti-inflammatory drug (NSAID) associated nephrotoxicity is uncommon during childhood in contrast to higher incidence in adults. A 12-year-old previously healthy boy was admitted to hospital with abdominal pain after ingestion of 275 mg of Naproxen bid for three days to relieve toothache. His physical examination was within normal limits except dental caries at left first premolar tooth. Erythrocyte sedimentation rate was 65 mm/hour and urine analysis showed (+) proteinuria and 8-10 erythrocytes with normal blood biochemistry. At fifth day of admission, his urea and creatinine levels increased to 85 mg/Dl and 4 mg/dL, respectively. Consecutively, he developed persistent microscopic hematuria and proteinuria of 12 mg/m2/hour. During his hospitalization, blood pressure remained stable and urine output was normal. A renal ultrasound demonstrated increased echogenicity of kidneys and percutaneous renal biopsy revealed tubulointerstitial nephritis. He was conservatively treated with intravenous hydration and supportive care. Renal function gradually returned to normal within 14 days. The popularity of NSAIDs continues to grow among physicians for pediatric use and many children use some form of NSAIDs on unprescribed basis. However, they can lead to severe nephrotoxicity even at therapeutic doses in healthy children. Although reported cases of naproxen induced renal failure are very few, appropriate precautions should be taken while treating children with naproxen.