Can Ibuprofen cause kidney failure?: What to make of the recent study in the news.

Ibuprofen, Advil, Motrin, Aleve, Naproxen...all medicines in the NSAID drug category which was linked to kidney failure in a recent study in the Journal of Pediatrics.  However, there are some limitations to this study.  At this point, Ibuprofen can still be used with caution(See below).  Here's the review:

The Study (the super-abbreviated version):

Researchers at the Riley Hospital for Children at Indiana University reviewed charts of patients admitted to their hospital from 1999-2010 for acute kidney injury.  Of the 1,015 patients in this review, 27 (or 2.7%) of them were identified to have NSAID-associated kidney injury as the sole cause of their kidney injury.  If you included patients who had NSAID-associated injury along with other causes, the amount increased to 6.6%.   However, in these patients,  it is hard to tell which cause was more contributory.

In the past, it was believed that this type (NSAID-associated) of kidney injury was mainly caused by overdosing the medication and/or contributory dehydration.  In this study, 18 of the 27 patients (67%) had a history of being dehydrated. In terms of overdosing, 20 of the 27 patients had a recorded history of how much parents were giving. Of the 20 patients, 15 (75%) had been given the appropriate dosing.  21 of the 27 patients had been using the NSAIDS for < 7 days. So, dehydration may have been a large factor for some of these patients but overdosing was not an overarching theme in this study.

Now, this study is limited by the fact that it is a retrospective review. Meaning that we are looking into the past at cases and trying to figure out what happened.  These studies are very helpful to find these types of problems, but can't 100% prove causality   Ideally, we would have a study where one group of children were given NSAIDS and another group was given a placebo(sugar pill) and to follow them over a period of time to see who developed kidney injury.  Unfortunately, this study has not been done (and may not be done).   This study does, however; give us pause and helps us to realize that not all medicines we use over the counter are 100% safe.  It also help us know where more studies need to be done.

Overall, here are some thoughts about what to do now:

1) If your child is on one of these medicines for an underlying medical problem (Arthritis, migraine, etc) speak with your doctor before stopping the medicine.

2) Always think twice before giving your child any over-the-counter medicine.  Think about whether or not treatment is really necessary or if you are treating your child because you feel like you need to do something (Yes, I am guilty here too!)

3) Don't always treat a fever (see my fever blog for more information)

4) Don't give ibuprofen (or any medicine for that matter) to prevent a fever.

5) Don't always give ibuprofen for pain. While I am certainly not saying that you should let your child be in pain, if the pain is mild it's always good to think about other remedies, like massage or rest, and only give medications if they don't work.

6) If you are planning to give an NSAID then make sure your child is drinking well and is not vomiting or having signs of dehydration. 

7) If you just aren't sure what to do, call your doctor.  We are a great resource and don't mind the call!