Renal dysfunction associated with the perioperative use of diclofenac

Postoperative renal dysfunction in rats is induced by ketorolac dosed concu rrently with gentamicin. Herein, we report the renal effects of diclofenac in four groups of rats: control (C = anesthesia, surgery); diclofenac (D = anesthesia, surgery, diclofenac 18 mg . kg(-1) . d(-1)); gentamicin (G = an esthesia, surgery, gentamicin 20 mg . kg(-1) . d(-1)); and diclofenac and g entamicin (DG = anesthesia, surgery, diclofenac, gentamicin). Renal functio n, after three treatment days, was assessed using histology, p-aminohippura te (PAH), and iothalamate (IOT) clearances, serum and urine electrolytes, o smolality, urea, and creatinine. Urine output was increased (from 5.2 to 12 .5 mL/24 h), and urine osmolality was decreased (from 2121 to 883 mOsm/kg) in the DG group. PAH and IOT clearances were decreased in the G and DG grou ps (PAH by 18%, IOT by 22%; PAH by 38%, IOT by 43%, respectively); there we re no changes in the C and D groups. Urea and creatinine clearances were de creased by 61% and 43%, respectively, in the DG group. Kidney sections show ed the most severe pathologic changes in the DG group. Our data indicate th at the perioperative combination of diclofenac and gentamicin was deleterio us to renal function. Implications: Diclofenac alone does not result in sig nificant perioperative renal dysfunction, but the combination of gentamicin and diclofenac is deleterious to renal function. Considering this and prev ious findings, the evidence suggests that treatment with aminoglycosides ma y be a significant risk factor for inducing perioperative renal failure dur ing treatment with nonsteroidal antiinflammatory drugs.