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Re: COX 2 inhibitors in pregnancyFrom: art fougner, md (evsono@pipeline.com)Wed Jul 28 13:31:16 2004
a cautionary anecdote ... Minerva Urol Nefrol. 2001 Jun;53(2):113-6. Related Articles, Links [Neonatal chronic kidney failure associated with cyclo-oxygenase-2 inhibitors administered during pregnancy] [Article in Italian] Peruzzi L, Gianoglio B, Porcellini G, Conti G, Amore A, Coppo R. Nefrologia e Dialisi, Ospedale Infantile Regina Margherita, Turin, Italy. Non-steroidal anti-inflammatory drugs (NSAID) are used since years as tocolytic due to their capacity to inhibit cyclo-oxygenase (COX) expressed in uterus and fetal membranes, fundamental for labour initiation and maintenance. The use of nimesulide, a COX-2 selective NSAID, has been recently proposed due to its capacity to selectively inhibit the enzyme expressed in the myometrium and endometrium. A case of neonatal irreversible end stage renal failure after maternal assumption of nimesulide as tocolytic for 6 week is reported. Cesarean section at the 32nd week due to oligohydramnios gave birth to a baby girl of 2090 g, in good general conditions, without signs of respiratory distress and of visible abnormalities. From birth she displayed oligo-anuria which required dialytic substitutive therapy from the second day of life. At US scan both kidneys had normal diameters for gestational age slightly increased echogenicity and a reduced cortico-medullary differentiation. On the 20th day of life she had a surgical renal biopsy for the persistence of oligo-anuria, showing fetal glomeruli, without lymphocytic interstitial infiltrate, and normal tubuli without evidence of necrosis. She is now 16 months old and under automated peritoneal dialysis on a home dialysis program. The occurrence of chronic renal failure in strict relationship with maternal nimesulide assumption in this case is strongly suggestive for a pharmacological damage, either direct or mediated by renin angiotensin inhibition, and possibly modulated by genetic factors, likely to account for the different outcome of similarly treated patients. A cautious use of this drug as long term tocolytic should be recommended while waiting for ad hoc experimental and clinical evidences of safeness. art
At Wed, 28 Jul 2004, Richard Chudacoff, MD wrote:
>
-- art fougner, md ich bin ein New Yorker
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