Nephrotoxicity of selective COX-2 inhibitors

We describe 2 male patients, a 49-year-old with psoriatic arthritis and imp aired renal function and a 43-year-old renal transplant recipient, who both sustained a marked decline in glomerular filtration rate in conjunction wi th a selective inhibitor of cyclooxygenase-2 (COX-2), rofecoxib. In the sec ond patient, acute renal failure necessitated hemodialysis. Both patients m ade an uneventful recovery. Our report lends further support to the assumpt ion that COX-2 inhibitors, as a class, can be as nephrotoxic as their nonse lective predecessors. Therefore, COX-2 inhibitors should be used with cauti on in renal transplant recipients and in patients with salt depletion and r enal insufficiency.