Diclofenac
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Various toxicities: case report A 24-year-old man developed analgesic nephropathy in the form of end stage renal disease, pulmonary oedema, left ventricular dysfunction and reduced kidney size during treatment with diclofenac for ankylosing spondylitis. The man presented to hospital on 24 February 2019 with pedal oedema, breathlessness, reddish discoloration of urine and decreased urination. Four years previously, he had developed symptoms of lower back pain, for which, he received tablet diclofenac 150mg a day in three divided doses [route not stated]. On 11 August 2016, a diagnosis of ankylosing spondylitis was confirmed and treatment with diclofenac was continued with an exercise regimen. On presentation, urine examination revealed the presence of protein and blood in a high amount, signifying glomerular injury. Serum creatinine was found to be 16 mg/dL. Chest X-ray showed a bat-wing appearance signifying pulmonary oedema. Abdominal ultrasound showed small sized kidney with loss of corticomedullary differentiation and raised cortical echogenicity. Moderate fluid was observed in the pleural bilaterally and free fluid was observed in the peritoneal cavity. Serum PTH was found elevated suggesting renal osteodystrophy. On 25 February 2019, echocardiography showed LVEF of 35% with global LV hypokinesia, RVSP of 42 mm Hg and severe mitral regurgitation significant for pulmonary arterial hypertension. Based on the finding analgesic nephropathy with end stage renal disease was considered. He was also diagnosed with dilated cardiomyopathy [duration of treatment to reaction onset]. The man received empirical treatment with metronidazole, piperacillin-tazobactam and azithromycin. Along with this, he also prescribed aspirin, heparin, atorvastatin, clopidogrel, prednisolone, furosemide, sevelamer and hydroxychloroquine. He underwent haemodialysis twice and transferred to the nephrology department for renal transplant [outcome not stated]. Pandit S, et al. Analgesic nephropathy due to diclofenac in a 24-year-old Indian male patient: A case report. Journal of Young Pharmacists 12: 291-293, No. 3, Sep 2020. 803514525 Available from: URL: http://doi.org/10.5530/JYP.2020.12.79
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Reactions 14 Nov 2020 No. 1830
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