A 60-year-old woman is being evaluated for abnormal renal function. She is found to have a serum creatinine of 2.2 mg/dL on routine laboratory monitoring; her creatinine level a year ago was 1.2 mg/dL. The patient has a history of nonischemic cardiomyopathy and systolic heart failure and has been on a stable medical regimen for the past 2 years. She has no dyspnea, fever, rash, or lower extremity swelling but has been taking ibuprofen for 2 weeks due to left knee osteoarthritis. Urinalysis reveals the following: Ibuprofen is discontinued, and her kidney function returns to normal in a week. Which of the following best explains this patient's transient deterioration in renal function?

Question

A 60-year-old woman is being evaluated for abnormal renal function.  She is found to have a serum creatinine of 2.2 mg/dL on routine laboratory monitoring; her creatinine level a year ago was 1.2 mg/dL.  The patient has a history of nonischemic cardiomyopathy and systolic heart failure and has been on a stable medical regimen for the past 2 years.  She has no dyspnea, fever, rash, or lower extremity swelling but has been taking ibuprofen for 2 weeks due to left knee osteoarthritis.  Urinalysis reveals the following:  Ibuprofen is discontinued, and her kidney function returns to normal in a week.  Which of the following best explains this patient's transient deterioration in renal function?

Quizplus · Accepted Answer

Eductional Objective: Patients with intravascular volume depletion (eg, congestive heart failure, diarrhea, excessive diuresis) and chronic kidney disease depend on renal prostaglandin production to dilate the afferent glomerular arteriole and maintain the glomerular filtration rate.  Nonsteroidal anti-inflammatory drugs inhibit prostaglandin synthesis, which can cause prerenal azotemia in at-risk patients.

A 60-Year-Old Woman Is Being Evaluated for Abnormal Renal Function