Ketorolac-induced irreversible renal failure in sickle cell disease: a case report

Byline: A. M. Simckes (1), Selina S. Chen (2), Alexies V. Osorio (1), Robert E. Garola (3), Gerald M. Woods (4) Keywords: Key wordsaNonsteroidal anti-inflammatory drug; Ketorolac; Sickle cell disease; Perirenal hematoma; Renal failure Abstract: aNonsteroidal anti-inflammatory drugs are often used in the management of those with acute pain secondary to sickle cell disease due to potent analgesic effects along with a lack of addictive potential, respiratory depression, and central nervous system effects, as may occur with narcotics. Caution should be observed in the use of nonsteroidal anti-inflammatory drugs in patients with compromised renal function. We present a case of a 17-year-old sickle cell disease patient with an acute painful episode and normal renal function indices who subsequently developed irreversible renal failure and a perirenal hematoma following the administration of ketorolac, despite adequate hydration. Due to its inhibitory effect on prostaglandin-mediated vasodilation, we advise caution in the use of ketorolac for the pain management of sickle cell painful episodes. We recommend following the administration guidelines for ketorolac for renal-compromised patients in those with painful episodes of sickle cell disease, and if used in this patient population, renal function must be very closely monitored. Author Affiliation: (1) Section of Pediatric Nephrology, The Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA Tel.: +1-816-234-3010, Fax: +1-816-234-3494, US (2) School of Medicine, University of Missouri at Kansas City, Kansas City, Missouri, USA, US (3) Department of Pathology, The Children's Mercy Hospital, Kansas City, Missouri, USA, US (4) Section of Pediatric Hematology-Oncology, The Children's Mercy Hospital, Kansas City, Missouri, USA, US Article note: Received: 24 March 1998 / Revised: 5 June 1998 / Accepted: 10 June 1998