Neck Pain in Children – NSAIDs Linked to Acute Kidney Injury

Many kids suffer from neck pain but a new study suggests a serious risk of acute kidney injury (AKI) in kids taking NSAIDs for pain, especially when they are also dehydrated. How can we safely treat neck pain in our kids and what can we do to reduce the risks if NSAIDs seem necessary?

NSAIDs Most Common Avoidable Risk for AKI in Kids

The latest research, courtesy of the Riley Hospital for Children in Indianapolis, found that 2.7% of children admitted to hospital with acute tubular necrosis and acute interstitial nephritis had been given NSAIDs before ending up in emergency. Publishing their findings in the Journal of Pediatrics, Jason M. Misurac, MD, and colleagues from the Indiana University School of Medicine in Indianapolis noted that NSAIDs are perhaps “the most common avoidable AKI risk to which children are regularly exposed.”

Kids at Risk Even When Dosage Guidelines Followed

The majority of the children (78%) admitted to the hospital with acute kidney injury during this study period had been using NSAIDs for less than a week with ibuprofen the most popular (67%) type of pain relief medication for the kids. Naproxen accounted for some 11% of NSAID use, and ketorolac 7%. Three-quarters of the children were judged to have been given an appropriate dose of the medication, which highlights the risks for every child even when parents or guardians are diligent about following medication guidelines.

Holding off on NSAIDs for Kids with Neck Pain

A key factor in the risk of AKI with NSAID use in kids seems to be dehydration. Knowing the symptoms of dehydration, such as vomiting (seen in 74% of these children), decreased urine output (56% of the kids) and diarrhoea (seen in 26%), could help parents to make better informed choices about pain medications and pain relief in general. Such insight may also help first line medical personnel hold off on administering NSAIDs until a renal (kidney) evaluation has been carried out, as well as getting children on rehydration fluids promptly.

Younger Children at Most Risk of NSAID-Induced Acute Kidney Injury

Luckily, none of the children in this study died or had permanent kidney failure, although almost a third (30%) had signs of mild chronic kidney damage that persisted post-acute kidney injury. Perhaps unsurprisingly, the youngest children were more likely to be negatively affected by severe AKI, although most patients in the study were actually teenagers.

Are Kidney Injuries from NSAIDs More Common than Reported?

Peritoneal dialysis was needed for all the young children (<5yrs old) admitted with AKI after NSAID use, with intensive care unit admission for three-quarters of these patients. The result was a longer hospital stay for the children (10 days vs 7 days for older children and teens). Those under five years old appear to be more at risk of NSAID nephrotoxicity and the authors also question the reported levels of acute kidney injury, hypothesising that there may be many more cases than are cataloged. Multifactorial AKI often had NSAID exposure as one of the risk factors but were not listed solely as an NSAID-induced kidney injury, for example.

Spotting Signs of Kidney Injury in Children

Due to the fact that the researchers only assessed cases after admittance to hospital, the results do not allow for conclusions to be drawn regarding the connection between NSAID use in kids and kidney injury. All of the children in the study were reported as having been previously healthy and so many of them had never had kidney function assessed. The major factor appears to be dehydration, however, so it would be wise to limit NSAID use in children suffering from dehydration and be on the lookout for acute symptoms of kidney dysfunction such as fatigue, loss of appetite, headache, vomiting, lower back pain and pain in the flanks, urinary difficulties and water retention, as well as irregular heartbeat and palpitations.

Neck Pain Relief for Children

Children suffering from neck pain may, indeed, benefit from the use of NSAIDs to break the cycle of pain and tension but many are better served by alternative pain relief treatments such as acupuncture, acupressure, gentle massage, a hot bath or application of a heated neck wrap (or cooling neck wrap if there is inflammation). Taking a look at causes of neck pain in kids is also important. That way, you can remove neck pain triggers and reduce your child’s risk of acute kidney injury from NSAIDs.

Reference

Jason M. Misurac, Chad A. Knoderer, Jeffrey D. Leiser, Corina Nailescu, Amy C. Wilson, Sharon P. Andreoli, Nonsteroidal Anti-Inflammatory Drugs Are an Important Cause of Acute Kidney Injury in Children, J Pediatr. Published online January 28, 2013.


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