Hematuria NSAIDs

A series of 11 spontaneously reported cases in which renal impairment was associated with the use of nimesulide has been described (17). The adverse events were represented by acute renal insufficiency n — 2), acute deterioration of chronic renal insufficiency n — 3), fluid retention n = 4), and oliguria and macro hematuria n = 1 each). The patients had a median age of 57 (range 17-81) years and six had some predisposing condition (chronic renal insufficiency, heart failure, diabetes, use of diuretics) to NSAID-induced functional renal impairment. Apart from one patient, nimesulide was taken for a very short time (less than 8 days). A favorable outcome ensued after withdrawal of therapy in aU patients. The acute deterioration of renal function described in these patients pointed to hemodynamically mediated renal impairment in all cases, with the exception of one man in whom interstitial nephritis was suspected. 

A clinical algorithm for the management of hematuria, for example in patients taking penicillamine or NSAIDs, has been published (238). It should be borne in mind that in such patients hematuria may be symptomatic of underlying pathology (for example a tumor of the urinary tract). 

The clinical circumstances that lead to chronic "analgesic abuse" nephropathy [111] are quite distinct to the rare occurrence of acute papillary necrosis associated with exposure of fhe patient to a single NSAID and often with only a short period of drug exposure. In these acute circumstances, the patient will typically present clinically with gross hematuria and may have flank pain suggestive of ureteric obstruction consequent to the passage of a sloughed papilla. 

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