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Abstract

M. Horackova, O. Sch

¹Department of Medicine, ²nd Medical Faculty of Charles University, ²Department of Nephrology, and ³Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Considering the increasing popularity and prescribing of specific COX-2 inhibitors, a new class of NSAIDs lacking gastrointestinal side effects, the evaluation of their effects on renal function has become very important. Objective: The aim of the study was to evaluate the effect of rofecoxib on GFR, proteinuria and the renin-angiotensin-aldosterone system (RAAS) in elderly patients with chronic renal impairment under controlled conditions of water and salt intake. Subjects: There were ten patients (average age 67 years, range 53 ? 80 years) with analgesic or vascular nephropathy (average GFR 54 ml/min/1.73 m², range 30 ? 79 ml/min/ 1.73 m²) given 25 mg rofecoxib daily for seven days under balanced conditions of water and sodium metabolism (salt intake 6 ? 8 g/24 hours). Methods: The effect of rofecoxib on GFR measured using inulin clearance (C_in), creatinine clearance (C_Cr) serum cystatin C concentration (S_cystatin), tubular creatinine secretion (using the ratio C_Cr/C_in), 24-hour urinary excretion of albumin (U_albV) and prostaglandins (U_PGE2V and U_PGF2aV), basal and stimulated plasma renin activity (PRA) and serum aldosterone concentration (S_aldosterone) was evaluated before and on Day 7 during rofecoxib treatment. Results: Rofecoxib did not significantly change C_in, C_Cr, S_cystatin, C_Cr/C_in and U_albV. However, U_PGE2V and U_PGF2aV were decreased during rofecoxib administration (p = 0.059 and p = 0.024, respectively). Rofecoxib attenuated the stimulated rise of PRA and S_aldosterone (p = 0.019 and p = 0.008, respectively). Conclusions: Short-term rofecoxib administration was not associated with significant change in GFR in elderly patients with moderate chronic renal impairment under conditions of balanced salt and water metabolism despite significant attenuation of RAAS activity. Since the C_Cr/C_in ratio did not change in our study, we assume rofecoxib to have no influence on creatinine tubular secretion.Correspondence to:
Dr. M. Horackova Department of Medicine 2nd Medical Faculty of Charles University University Hospital Motol V Uvalu 84 150 06 Prague 5, Czech Republic
Email: [email protected]

Abstract

O. Schück and M. Horackova

Department of Internal Medicine, ²nd Faculty of Medicine, University Hospital, Charles University in Prague, Czech Republic
Correspondence to:
M. Horackova, MD, PhD; Department of Internal Medicine 2nd Faculty of Medicine, University Hospital, Motol V Uvalu 84, 150 06 Prague 5, Czech Republic
Email: [email protected]

Abstract

Nieren- und Hochdruckkrankheiten, Jahrgang 31, Nr. 11/2002, S. 522-526

Analgetika-Nephropathie – Situation in Tschechien

M. Horackova¹ und V. Teplan²

¹Nephrologische Abteilung, Medizinische Klinik I, ³. Medizinische Fakultät,
Karls-Universität, Prag, ²Nephrologische Klinik, Institut für klinische und
experimentale Medizin, Prag
In der Pathogenese der Analgetikanephropatie
spielt der Verbrauch von analgetischen
Mischpräparaten eine wichtige Rolle.
Die multikomponenten Analgetika standen
auf dem tschechischen Markt bis Ende der
90er Jahre des vorigen Jahrhunderts zur Verfügung.
Die phenacetinhaltigen Mischpräparaten
haben 12,5% und andere analgetische
Mischpräparate (2 analgetische Komponenten
und mindestens eine psychoaktive Substanz)
22% der Produktion von allen nichtnarkotischen
Analgetika gebildet. Der Gipfel
des Verbrauchs von analgetische Mischpräparate
lag bei 100 Einheiten pro 1000 Einwohner
und Tag in der ehemaligen Tschechoslowakei
im Zeitraum von 1971 bis 1985. Der
Verbrauch von nonsteroidalen Antirheumatika
(NSA) und von Parazetamol hat die analgetischen
Mischpräparate Ende der 80er Jahre
des vorigen Jahrhunderts ersetzt. Eine multizentrische
Studie, die 1992 in Tschechien
durchgeführt wurde, hat gezeigt, daß die Inzidenz
der Analgetikanephropathie 10,4% erreichte.
Das übertrifft die Angaben der European
Dialysis and Tranplant Association um
mehr als Doppelte.Correspondence to:
Dr. med. M. Horackova
Nephrologische Abteilung
Medizinische Klinik I
3. Medizinische Fakultät
Karls-Universität
Srobarova 50
CZ-10034 Prag 10

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