Oliguria NSAIDs

The authors reported that two other cases of metformin-associated lactic acidosis with concurrent NSAID therapy have been reported to the Committee on Safety of Medicines in the UK. Indometacin can impair kidney function and may have done so in this case. Phenformin can cause tubular damage and oliguria in animals (145) and so it is conceivable that metformin-induced renal damage may also have contributed. 

Many patients have non-oliguric acute renal failure, with a good prognosis. However, some patients require dialysis. For treatment, hydration must be controlled, and nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided if possible. When oliguria is observed, dialysis therapy should be performed, as described for acute tubular necrosis. 

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. 

Paracetamol at high doses (over 4 g/day), liver toxicity is possible, especially in patients with chronic liver disease (viral or alcohol related) NSAID increased risk of gastrointestinal bleeding oliguria/anuria due to sodium and water retention hyperkalemia worsening of renal function... 

---