misoprostol and Kidney-Diseases

Despite their propensity to cause toxicity, nonsteroidal anti-inflammatory drugs (NSAIDs) are routinely prescribed for older patients for painful musculoskeletal conditions, many of which are noninflammatory in nature. In some settings, simple analgesia with paracetamol (acetaminophen) or tramadol may be just as effective as NSAIDs. The benefits of therapy with NSAIDs must be weighed against their potential risks. With the anticipated growth of the elderly population, the economic implications of NSAID use in older patients are staggering. Estimates of the total cost of prescribing NSAIDs to the elderly must include the additional costs of gastroprotective agents, prophylaxis, laboratory monitoring, physician evaluations and interventions for adverse effects. Misoprostol may be cost effective as primary prophylaxis of NSAID-induced ulcer disease in some elderly patients. NSAIDs may reduce disability and improve quality of life, thereby offsetting their costs. To date, the direct, indirect and intangible cost of NSAIDs and cost offsets have not been systematically evaluated in the elderly. At this juncture, NSAIDs may be used judiciously in older patients, and misoprostol should be considered in high risk patients. Further studies to assess the economics of NSAIDs in the elderly population are warranted.

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Anti-Ulcer Agents; Costs and Cost Analysis; Female; Gastrointestinal Diseases; Humans; Kidney Diseases; Male; Misoprostol; Risk Factors

Topics: Alprostadil; Anti-Inflammatory Agents, Non-Steroidal; Humans; Kidney Diseases; Misoprostol; Prostaglandins

Patients with cirrhosis are prone to develop renal failure upon administration of nonsteroidal anti-inflammatory drugs. The aim of the present study was to determine the safety and efficacy of misoprostol (400 microg) in two repeated doses for the prevention of ibuprofen-induced decrements in renal function in decompensated cirrhotics.. Patients were given ibuprofen (800 mg) with either misoprostol (n = 9) or a placebo (n = 10). Sixty minutes later another dose of misoprostol or the placebo was administered. Renal function tests were assessed by clearance techniques.. Administration of ibuprofen with a placebo caused significant decreases in urinary output, inulin clearance, sodium excretion, osmolar clearance, free water clearance, and urinary prostaglandin E2 excretion. Coadministration of ibuprofen and the first misoprostol dose maintained urinary output and sodium excretion, and caused an increase in free water clearance. These changes were maintained only for 1 h. Administration of the second dose of misoprostol temporarily improved inulin and creatinine clearances. Half the patients who received misoprostol suffered from episodes of chills, fever, and diarrhea.. Ibuprofen causes renal dysfunction in decompensated cirrhotics, whereas misoprostol may have some protective renal effects, which are, however, short lived and clinically insignificant. Because of side effects, misoprostol should be used with caution in these patients.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Double-Blind Method; Female; Glomerular Filtration Rate; Humans; Ibuprofen; Kidney Diseases; Liver Cirrhosis; Male; Middle Aged; Misoprostol; Placebos; Statistics, Nonparametric; Treatment Outcome

Misoprostol is effective in protecting the gastric mucosa against various injuries (cytoprotection), but its role in preventing peptic ulcer disease (PUD) is controversial. Therefore, this study was designed to evaluate the effect of misoprostol on preventing posttransplant PUD. 87 patients undergoing kidney transplantation (KT) were randomly separated into three groups according to the antiulcer regimen. Group 1 (n = 28) received antacid and ranitidine; group 2 (n = 34) received antacid, ranitidine, and bismuth (De Nol), and group 3 (n = 25) received antacid, ranitidine, and misprostol (prostaglandin E1). Antiulcer drugs started 1 week before KT and were continued after surgery. A pretransplant gastrofibroscopy was performed 1 month before KT, and a follow-up gastroscopy was performed 2-3 weeks after KT. The incidence of peptic ulcer in groups 1 and 2 was 50.0% (14/28) and 35.3% (12/34), respectively (p > 0.05 groups 1 vs. 2). In group 3, 12.0% (3/25) of the patients showed PUD (p < 0.05 when compared with group 1 or 2). The known risk factors of posttransplant PUD were not significantly different in three groups, but the KT recipients of groups 1 and 2 had 7.8 times the risk of PUD when compared with group 3. In conclusion, the antiulcer regimen including misoprostol is more effective than ranitidine or bismuth in preventing posttransplant PUD, and the antiulcer effect of misoprostol seems to be related to the cytoprotective effect of the drug.

Topics: Adult; Anti-Ulcer Agents; Evaluation Studies as Topic; Female; Gastric Mucosa; Gastroscopy; Humans; Kidney Diseases; Kidney Transplantation; Male; Middle Aged; Misoprostol; Peptic Ulcer; Risk Factors; Time Factors; Treatment Outcome

To evaluate the possible protective effects of misoprostol on renal function in hospitalized elderly patients treated with indomethacin.. Forty-five hospitalized elderly patients (> 65 years old) who required therapy with nonsteroidal antiinflammatory drugs (NSAID) were randomly assigned to receive either indomethacin, 150 mg/day (Group A), or indomethacin 150 mg/day plus misoprostol at 0.6 mg/day (Group B). Laboratory variables of renal function [serum creatinine, blood urea nitrogen (BUN) and electrolytes] were evaluated before initiation of therapy and every 2 days, until termination of the study (a period of at least 6 days). Response to treatment was estimated by the visual analog scale for severity of pain.. Forty-two patients completed the study, 22 in Group A and 20 in Group B. BUN and creatinine increased by > 50% of baseline levels in 54 and 45% of Group A patients, respectively, compared to only 20 and 10% of Group B patients (p < 0.05). Potassium (K) increment of 0.6 mEq/l or more was observed in 50% of Group A, but in only 15% of Group B patients (p < 0.05). The mean increments in BUN, creatinine, and K were reduced by 63, 80, and 42%, respectively, in Group B patients compared to Group A. Response to treatment did not differ significantly between the 2 groups.. Hospitalized elderly patients are at risk for developing indomethacin related renal dysfunction. Addition of misoprostol can minimize this renal impairment without affecting pain control.

Topics: Aged; Aging; Drug Therapy, Combination; Female; Hospitalization; Humans; Indomethacin; Kidney Diseases; Male; Misoprostol; Pain; Prospective Studies; Risk Factors

To assess whether the synthetic prostaglandin misoprostol is renal protective in rheumatoid arthritis (RA) patients who are beginning cyclosporin A (CSA) therapy.. In this randomized, placebo-controlled, multicenter trial, 50 patients with active RA were randomized to receive either misoprostol (800 micrograms/day) or placebo for 16 weeks. After 2 weeks of pretreatment with misoprostol or placebo, all patients concomitantly received CSA at an initial and maximum dosage of 5 mg/kg/day for 12 weeks.. A significant increase in the serum creatinine level was observed in both treatment groups, with no difference noted between groups. There was a high withdrawal rate in both groups, primarily due to adverse events.. A renal-protective effect was not demonstrated for misoprostol compared with placebo in RA patients who are beginning CSA therapy.

Topics: Adult; Aged; Arthritis, Rheumatoid; Cyclosporine; Female; Gastrointestinal Diseases; Humans; Hypertension; Kidney; Kidney Diseases; Male; Middle Aged; Misoprostol; Placebos; Prospective Studies

The aim of this prospective and randomized study was to determine whether misoprostol, an analogue of PGE1, could decrease the incidence and the number of rejection episodes and could improve the renal function over a 12-month follow-up, when given at 400 micrograms/day for 12 months in renal transplant patients. Given the known side-effects and the additive cost of misoprostol, a benefit of the therapy should be a decrease of at least 50% in the incidence of rejection episodes in the treated group. Therefore, 60 consecutive renal transplant patients were randomized to receive misoprostol or to receive aluminium and magnesium hydroxide. Patients received steroids, azathioprine, antithymocyte globulins, and cyclosporin A (CsA). CsA was randomly started on day 0 or on day 8. At 12 months, no difference in the incidence of rejection episodes was observed: 63.3% in the 30 patients of the misoprostol + group versus 70.0% in the misoprostol-group (P = 0.558 Mantel-Cox). The renal function, assessed by plasma creatinine, inulin, and para-aminohippuric acid clearances, was not significantly different between misoprostol + and misoprostol-groups. No episode of CsA nephrotoxicity was observed in any patient of group one or group two. At 12 months, the mean dosage of CsA was 4.9 +/- 0.28 mg/kg/day in the misoprostol + group versus 4.52 +/- 0.23 mg/kg/day in the misoprostol-group and the trough level was not significantly different between the two groups. The graft survival rate at 12 months was 86.7% in the Misoprostol + group and 83.33% in the misoprostol-group.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Disease; Administration, Oral; Cyclosporine; Female; Graft Rejection; Humans; Incidence; Kidney; Kidney Diseases; Kidney Function Tests; Kidney Transplantation; Male; Misoprostol; Prospective Studies

An age greater than 60 and diuretic use have been implicated as risk factors for nonsteroidal anti-inflammatory drug (NSAID)-induced decreases in renal function. Misoprostol, a prostaglandin E1 analog, was studied in nine elderly osteoarthritic patients at risk for NSAID-induced renal dysfunction to determine whether it could prevent NSAID-induced renal dysfunction. Subjects received ibuprofen 2400 mg/day and either misoprostol 800 mcg/day or placebo for 14 days in a randomized, double-blinded, crossover trial. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) studies using inulin and PAH plasma clearance, urinary prostaglandin E2 (PGE2) and protein excretion, and serum electrolytes were obtained at baseline, after the first dose, and on day 7 and 14 of each treatment period. Prostaglandin E2 excretion was significantly reduced after the first dose of ibuprofen and throughout the 14 days in both the misoprostol and placebo treatment groups. No statistically significant differences in GFR, ERPF, protein excretion, serum potassium, or serum sodium were detected between misoprostol and placebo treatment during the 14 days of ibuprofen treatment. However, a subset of two patients who exhibited a decrease of greater than 20% in GFR during placebo treatment, appeared to demonstrate an attenuation of this decline when treated with misoprostol. Effect of time, independent of treatment group, indicated that ERPF was significantly decreased from baseline after the first dose of ibuprofen (P < or = 0.05), whereas GFR was notably diminished from baseline on day 14 only (P < or = 0.05). Misoprostol does not influence GFR and ERPF in unselected subjects purportedly at risk for NSAID-induced renal dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Anti-Inflammatory Agents, Non-Steroidal; Dinoprostone; Double-Blind Method; Female; Glomerular Filtration Rate; Humans; Ibuprofen; Kidney Diseases; Kidney Function Tests; Misoprostol; Osteoarthritis; Renal Circulation; Risk Factors

Nonsteroidal anti-inflammatory drugs (NSAIDs) can produce adverse effects by inhibiting prostaglandin (PG) synthesis. A PGE1 analogue, misoprostol, is often utilized to alleviate NSAID-related gastrointestinal side effects. This study examined the effect of misoprostol on celecoxib renal toxicity. Additionally, the effects of these drugs on cardiovascular parameters were evaluated. Four randomized rat groups were orally gavaged for 9 days, two groups receiving vehicle and two groups receiving misoprostol (100 µg/kg) twice daily. Celecoxib (40 mg/kg) was co-administered once daily to one vehicle and one misoprostol group from days 3 to 9. Urine and blood samples were collected and blood pressure parameters were measured during the study period. Hearts and kidneys were harvested on final day. Day 2 urinary electrolyte samples revealed significant reductions in sodium excretion in misoprostol (0.12 ± 0.05 µmol/min/100 g) and misoprostol+celecoxib groups (0.07 ± 0.02 µmol/min/100 g). At day 3, all treatment groups showed significantly reduced sodium excretion. Potassium excretion diminished significantly in vehicle+celecoxib and misoprostol+celecoxib groups from day 3 onward. Urinary kidney injury molecule-1 levels were significantly increased in vehicle+celecoxib (0.65 ± 0.02 vs. 0.35 ± 0.07 ng/mL, p = 0.0002) and misoprostol+celecoxib (0.61 ± 0.06 vs. 0.37 ± 0.06 ng/mL, p = 0.0015) groups when compared to baseline; while plasma levels of cardiac troponin I increased significantly in vehicle+celecoxib (p = 0.0040) and misoprostol+misoprostol (p = 0.0078) groups when compared to vehicle+vehicle. Blood pressure parameters increased significantly in all misoprostol treated groups. Significant elevation in diastolic (p = 0.0071) and mean blood pressure (p = 0.0153) was noted in misoprostol+celecoxib compared to vehicle+celecoxib. All treatments produced significant tubular dilatation/necrosis compared to control. No significant myocardial changes were noticed; however, three animals presented with pericarditis. Kidney, heart, and plasma celecoxib levels revealed no significant change between vehicle+celecoxib and misoprostol+celecoxib. Concomitant misoprostol administration did not prevent celecoxib renal toxicity, and instead exacerbated renal side effects. Misoprostol did not alter plasma or tissue celecoxib concentrations suggesting no pharmacokinetic interaction between celecoxib and misoprostol.

Topics: Administration, Oral; Aldosterone; Analysis of Variance; Animals; Blood Pressure; Blood Urea Nitrogen; Celecoxib; Electrolytes; Immunoblotting; Immunohistochemistry; In Situ Nick-End Labeling; Kidney Diseases; Misoprostol; Potassium; Pyrazoles; Rats; Sodium; Sulfonamides; Troponin I

Misoprostol has become a popular over the counter self-administered abortifacient in Ghana. This study aimed to compare the socio-demographic characteristics and clinical complications associated with misoprostol and non-misoprostol induced abortions among patients admitted to a tertiary public health facility in Ghana.. This was a cross sectional study conducted at the gynaecological ward of Komfo Anokye Teaching Hospital (KATH), over a four-month period using a structured pre-tested questionnaire. Data were analysed using Chi-square, Fisher's exact and student t-tests. Factors associated with severe morbidity were examined using Poisson regression with robust error variance to estimate crude and adjusted relative risks (RRs) with 95% confidence intervals (CIs). P < 0.05 was considered statistically significant.. Overall, 126 misoprostol users and 126 misoprostol non-users were recruited into the study. About 71% of the clients had self-induced abortions. Misoprostol users were more likely to be younger (p < 0.001), single (p < 0.001), nulliparous (p = 0.001), of higher educational background (p = 0.001), and unemployed (p < 0.001), than misoprostol non-users. Misoprostol users were more likely than non-users to undergo termination of pregnancy because they wanted to continue schooling (p < 0.001) or were not earning regular income to support a family (p = 0.001). Overall, 182 (72.2%) of the women (79.4% misoprostol users vs. 65.1% misoprostol non-users; p = 0.01) suffered severe morbidity. Nulliparous women (adjusted RR, 1.28; 95% CI, 1.08-1.52) and those who had induced abortion after 12 weeks' gestation (adjusted RR, 1.36; 95% CI, 1.18-1.57) were at increased risks of experiencing severe morbidity. The association between mode of abortion induction and severe morbidity was not statistically significant (p = 0.06).. Self-induced abortions using misoprostol is a common practice among women in this study; nearly three quarters of them suffered severe morbidity. Nonetheless, severe morbidity among misoprostol users and non-users did not differ significantly but was directly related to the gestational age at which the induced abortions occurred. Health education on the dangers of self-induced abortions and appropriate use of medication abortion could help reduce complications associated with induced abortions in Ghana.

Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Adult; Age Factors; Case-Control Studies; Cross-Sectional Studies; Educational Status; Employment; Female; Gestational Age; Ghana; Hospitals, Public; Humans; Kidney Diseases; Length of Stay; Liver Diseases; Misoprostol; Multivariate Analysis; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Self Care; Sepsis; Tertiary Care Centers; Uterine Hemorrhage; Young Adult

Cisplatin (CP) is a potent anticancer drug. However, it has side effects on kidney such as nephrotoxicity. Abnormal production of reactive oxygen species (ROS) has been accused in the etiology of CP-induced nephrotoxicity. Several ROS scavengers have been reported to prevent nephrotoxicity after CP administration. In this study, we used prostaglandin E1 (PGE1) analogues misoprostol (MP) to reduce this damage. MP has gained considerable interest as a ROS scavenger. Rats were received a single injection of CP (5 mg/kg, i.p.) with or without MP pretreatment (200 mcg/kg, orally). The renal tissue morphology was investigated by light microscopy. Trunk blood was also obtained to determine lipid peroxidation product malondialdehyde (MDA) and activity of antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT). CP administration increased MDA production and decreased SOD and CAT levels in the kidney tissue when compared to the control group. Morphological damage in CP administrated rats was also severe in the kidney tissue. MP treatment after CP application protected the renal tissues from CP's side effect. These findings indicate that MP has beneficial effects on CP induced nephrotoxicity in rats.

Topics: Animals; Antioxidants; Apoptosis; Catalase; Cisplatin; Cytoprotection; Kidney; Kidney Diseases; Lipid Peroxidation; Male; Malondialdehyde; Misoprostol; Oxidative Stress; Rats; Rats, Wistar; Reactive Oxygen Species; Superoxide Dismutase

Topics: Abortifacient Agents, Nonsteroidal; Abortifacient Agents, Steroidal; Abortion, Induced; Adult; Female; Humans; Kidney Diseases; Mifepristone; Misoprostol; Pregnancy; Pregnancy Complications; Severity of Illness Index

Cyclosporin A has markedly improved graft survival in transplant patients but its side effects, such as renal toxicity and hypertension, pose management problems in transplant recipients. This toxicity has been attributed to prostaglandin inhibition. Concurrent administration of misoprostol (a prostaglandin E1 analog) prevents chronic cyclosporin A-induced nephrotoxicity but not hypertension in rats.

Topics: Aldosterone; Animals; Atrial Natriuretic Factor; Blood Pressure; Chronic Disease; Creatinine; Cyclosporine; Drug Therapy, Combination; Electrolytes; Glomerular Filtration Rate; Heart Rate; Hypertension; Kidney Diseases; Misoprostol; Osmolar Concentration; Prostaglandins; Rats; Rats, Sprague-Dawley; Renal Circulation; Renin

In patients with underlying renal impairment, administration of nonsteroidal anti-inflammatory drugs (NSAID) can produce a marked reduction of renal function via inhibition of renal prostaglandin (PG) synthesis. Recent findings indicate that administration of misoprostol can at least partially prevent NSAID induced nephrotoxic effects, suggesting a role for exogenous PG in this setting. These agents may also have important immunomodulatory effects. Other recently reported data show that use of misoprostol in renal transplant patients receiving immunosuppressive therapy with cyclosporine and prednisone was associated with a significant reduction in the incidence of acute graft rejection, as well as improved graft function irrespective of the occurrence of rejection.

Topics: Administration, Oral; Alprostadil; Anti-Inflammatory Agents, Non-Steroidal; Clinical Trials as Topic; Humans; Kidney; Kidney Diseases; Kidney Transplantation; Misoprostol; Postoperative Care; Prostaglandin Antagonists; Prostaglandins

Renal prostaglandins (PG) play an important role in regulating renal hemodynamics and excretory function in 2 conditions (1) which effective arterial blood volume is reduced and (2) chronic renal failure is reduced. The use of nonsteroidal antiinflammatory drugs (NSAID) in patients with these conditions can produce a significant decline in renal function, including decreased glomerular filtration rate and solute and water excretion, by inhibiting renal cyclooxygenase, and thus, PG production. Results of preliminary investigation with the PGE1 analog misoprostol suggest that exogenous PG analogs may be effective in counteracting the effects of NSAID in such settings. Further clinical studies will be needed to establish the role of PG in this setting.

Topics: Alprostadil; Anti-Inflammatory Agents, Non-Steroidal; Anti-Ulcer Agents; Clinical Trials as Topic; Graft Rejection; Humans; Indomethacin; Kidney; Kidney Diseases; Kidney Transplantation; Misoprostol; Postoperative Care; Prostaglandins