Perinatal vasoconstrictive renal insufficiency associated with maternal nimesulide use

A full-term newborn developed oliguric renal failure at 24 hr of life, whic h persisted for several days. Her mother ingested therapeutic doses of nime sulide, a nonsteroidal anti-inflammatory (cyclo-oxygenase-2 inhibitor) drug , during the last 2 weeks of pregnancy. She was found at delivery to have d eveloped oligohydramnion, esophagitis, and a bleeding peptic ulcer. The inf ant's fractional excretion of sodium was very low (0.5%) pointing for a sev ere vasoconstrictive mechanism involved. Renal sonogram showed hyperechogen ic medullary papillae, which resolved during convalescence. This case empha sizes the importance of renal prostagandins in the control of vascular tone and sodium homeostasis. This is the first report of an adverse effect of f etal renal circulation by maternal ingestion of nimesulide.