Acute renal effects of sulindac and indomethacin in chronic renal failure

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Abstract
The effects of 2 days of oral dosing with sulindac (200 mg twice a day) or indomethacin [antinflammatory drug] (75 mg twice a day) on glomerular filtration rate, urinary excretion of prostaglandin E2, Na homeostasis and other renal function parameters were investigated in 8 patients with chronic stable impaired renal function. Indomethacin reduced creatibine clearance (from 41.0 .+-. 7.9-30.3 .+-. 6.3 ml/min) and increased serum levels of creatinine and .beta.2-microglobulin. Sulindac had no effect on any of these parameters. Both drugs induced depression of urinary prostaglandin E2 excretion; this depression was greater after indomethacin. Urinary Na excretion fell from 144.4 .+-. 18.7-85.5 .+-. 9.7 mmol/24 h after indomethacin and from 131.7 .+-. 11.6-103.4 .+-. 13.3 mmol/24 h after sulindac. Body wt increased 1.2 kg after indomethacin but was not changed by sulindac. Plasma renin activity was reduced from 2.3 .+-. 0.8-1.7 .+-. 0.6 nmol/l per h by sulindac and from 2.8 .+-. 0.8-1.5 .+-. 0.5 nmol/l per h by indomethacin. Urinary N-acetyl-.beta.-glucosaminidase and kallikrein excretion was not changed by either drug. Sulindac affects renal prostaglandin E2 synthesis and Na excretion in patients with severe renal failure to a lesser extent than does indomethacin. Sulindac seems to be the drug of choice of this group of patients, but glomerular filtration rate, body wt and electrolyte balance should be carefully monitored.