Diclofenac induced acute renal failure in a decompensated elderly patient
A 69 year old male patient was a known case of hypertension and receiving tablet atenolol 25 mg once a day since 3 years. He was diagnosed with spindle cell carcinoma on left thigh and was operated for it. Before surgery, he was given tablet furesemide 40 mg once a day and his anti-hypertensive drug was continued. On discharge after surgery, he was asked to continue his antihypertensive therapy with tablet atenolol 25 mg once a day and was also prescribed tablet ranitidine 150 mg twice a day, a combination of diclofenac 50 mg with serratiopeptidase 10 mg thrice a day and another combination of ampicillin 250 mg and cloxacillin 250 mg thrice a day for a total duration of 7 days.\nAfter 7 days, he visited outpatient department with complaints of swelling over legs and decreased frequency of micturition. On examination, the patient was alert and his pulse and blood pressure were within normal limits. He had no pallor, icterus, lymphadenopathy or clubbing but he had pedal edema. His respiratory, cardiovascular and central nervous systems were within normal limits.\nOn investigation, it was found that his plasma creatinine and urea were raised to 9.4 mg/dl and 99 mg/dl respectively. Among the electrolytes, plasma potassium and sodium were 4.9 mEq/L and 133 mEq/L, respectively. These values of these tests when done 4 days prior to surgery were creatinine 1 mg/dl, urea of 17 mg/dl, potassium 4.6 mEq/L and sodium 141 mEq/L. Urine proteins were within normal range with total protein 6.8 g/dl (normal 6.0-8.3 g/dl) urine albumin 3.47 g/dl (normal 3.2-5.0 g/dl) and urine globulin 3.34 g/dl (normal 3.2-5.0 g/dl). Urinary sodium was decreased 14.1 mEq/L (normal 25-50 mEq/L) and so the osmality to 34.2 mEq/L (normal values 100-260 mEq/L).\nFollowing the deranged report, his diclofenac was stopped and his investigations were repeated the following day, on day 5, day 10 and after 1 month. His plasma creatinine and urea levels didn’t show significant change on the following day but on day 5 the values started to drop towards normality with plasma creatinine 3.2 mg/dl, potassium 3.6 mEq/L and sodium 137 mEq/L. His pedal edema was also subsiding showing clinical improvement.\nOn subsequent visit, on day 10, his creatinine level further came down to 1.5 mg/dl, urea to 21 mg/dl, potassium 3.2 mEq/L and sodium 140 mEq/L. After one month, all the values returned within the normal range with creatinine 1.5 mg/dl and urea 16 mg/dl.