Renal disease and use of topical non-steroidal: anti-inflammatory drugs

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Abstract
Renal impairment is a recognised complication of oral, rectal, and intramuscular non-steroidal anti-inflammatory drugs. We report cases of renal disease associated with a topical preparation. ### Case 1 A 74 year old woman presented with a six week history of breathlessness and oedema. Investigations showed proteinuria (+ + + by dipstick), a serum albumin concentration of 17 g/l, and a creatinine concentration of 169 mumol/l. Her urine contained no leucocytes but grew Escherichia coli in culture and she was prescribed trimethoprim, frusemide, and prophylactic heparin. Her renal function deteriorated, and three days later she was transferred to our care. She was not volume depleted but remained grossly nephrotic with proteinuria of 18 g/day. There was no eosinophilia or eosinophiluria, and results of renal phlebography and ultrasonography were normal. Renal biopsy showed a florid interstitial nephritis with normal glomeruli. Serum …