Indomethacin-Induced Acute Renal Failure: Report of a Case and Review of the Literature

An 84-year-old black male with hypertensive cardiovascular disease and arthritis suffered deterioration in renal function when placed on indomethacin for an acute monoarticular arthritis. Renal function improved after discontinuing the indomethacin. The patient received indomethacin again, and there was a rapid increase in both the serum creatinine and blood urea nitrogen, which declined a second time when the drug was stopped. The plasma renin activity after indomethacin treatment was found to be markedly elevated. The counterbalancing effect of prostaglandins and plasma renin activity in preserving renal function in patients with underlying disease states is stressed. A review of the literature is provided and some rationalizations made as to what type of patient would be most susceptible to renal failure with indomethacin therapy.