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Case Reports
. 2018 Nov;7(2):195-197.
doi: 10.1007/s13730-018-0324-3. Epub 2018 Mar 22.

Furosemide-induced tubular dysfunction responding to prostaglandin synthesis inhibitor therapy in a child with nephrotic syndrome

T Harish Varma  1 , Ashish Sharma  1 , S Santhiya  1 , Lesa Dawman  1 , Karalanglin Tiewsoh  2
Affiliations
Case Reports

Furosemide-induced tubular dysfunction responding to prostaglandin synthesis inhibitor therapy in a child with nephrotic syndrome

T Harish Varma et al. CEN Case Rep. 2018 Nov.

Abstract

Furosemide is one of the most common drug used to treat anasarca in childhood nephrotic syndrome. It has minimal side effects on short-term usage, but prolonged use can result in polyuria, hypokalemia and metabolic alkalosis. This pseudo-bartter complication can be treated by discontinuation of the drug with adequate potassium replacement. We report a child who was given furosemide for 20 days elsewhere to treat the edema due to nephrotic syndrome and then presented to us with bartter-like syndrome. Furosemide was discontinued and potassium replacement was initiated. However, the child continued to have polyuria leading to repeated episodes of hypotensive shock. In view of severe symptoms, she was given a short course of oral indomethacin for 6 days, to which she responded. This case highlights the fact that indomethacin can provide symptomatic improvement in furosemide induced pseudo-bartter.

Keywords: Furosemide; Indomethacin; Metabolic alkalosis; Potassium; Pseudo bartter syndrome.

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Conflict of interest statement

Conflict of interest

All authors declare that they have no conflict of interest.

Research involving human participants and/or animals

Due permission from the Departmental Review Board was taken.

Informed consent

Taken.

Figures

Fig. 1
Fig. 1
Schematic representation of changing trend of urine output, metabolic alkalosis and serum potassium versus days of hospital stay. The yellow shaded area is the duration when indomethacin therapy was given
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