Evaluation of long-term treatment with indomethacin in hereditary hypokalemic salt-losing tubulopathies.

Autor: Reinalter SC; Department of Pediatrics, Philipps University, Marburg, Germany., Gröne HJ, Konrad M, Seyberth HW, Klaus G
Jazyk: angličtina
Zdroj: The Journal of pediatrics [J Pediatr] 2001 Sep; Vol. 139 (3), pp. 398-406.
DOI: 10.1067/mpd.2001.117007
Abstrakt: Objective: Evaluation of the benefit/risk ratio of long-term treatment with indomethacin in salt-losing tubulopathies with special attention to renal function.
Study Design: Twelve patients (median age, 14.9 years) had received indomethacin for a median of 13 years (median cumulative dose, 10.7 g/kg). Creatinine clearance, serum electrolyte levels, endocrine status, and excretion of prostaglandins and electrolytes were examined during indomethacin therapy and after its withdrawal. All patients underwent ultrasound-guided renal biopsy. For statistical evaluation, the Wilcoxon test and Pearson correlation coefficient were used.
Results: After indomethacin withdrawal, the biochemical features of the tubulopathy reappeared. The median creatinine clearance rose from 67.4 to 96.5 mL/min/1.73 m(2) (P <.05) but remained subnormal in 4 patients. Ultrasonography elucidated medullary nephrocalcinosis in 8 patients. Renal tissue showed slight/moderate focal tubular atrophy and interstitial fibrosis in 8 patients. Comparison with biopsy specimens, obtained 11 to 14 years before study participation from 5 patients, revealed no progression. A correlation between fractional sodium and magnesium excretion and percentage of altered tubulointerstitial compartment was found (P <.001). The 4 patients with mutations in the gene of the inwardly rectifying adenosine triphosphate-regulated potassium channel (ROMK) had almost normal renal histologic findings and normal renal function.
Conclusion: Renal function and histology are unaffected by long-term indomethacin treatment.
Databáze: MEDLINE
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