Stiftung Tierärztliche Hochschule Hannover (TiHo)

Single-dose diclofenac in healthy volunteers can cause decrease in renal perfusion measured by functional magnetic resonance imaging

Hellms, Susanne ORCID; Gueler, Faikah; Gutberlet, Marcel; Schebb, Nils Helge GND; Rund, Katharina; Kielstein, Jan T.; VoChieu, VanDai; Rauhut, Sebastian; Greite, Robert; Martirosian, Petros; Haller, Hermann; Wacker, Frank; Derlin, Katja

OBJECTIVES:We investigated changes of renal perfusion after topical and oral diclofenac administration in healthy volunteers using functional magnetic resonance imaging (MRI) with arterial spin labelling (ASL). METHODS:Twenty-four healthy human participants (21-51 years) underwent 1.5T MRI before and 1 h after a single oral dose of diclofenac (50 mg). Twelve of 24 participants underwent an additional MRI examination following 3-day topical diclofenac administration. For renal perfusion imaging, a flow-sensitive alternating inversion-recovery TrueFISP ASL sequence was applied. Plasma concentrations of diclofenac and serum concentrations of thromboxane were determined. KEY FINDINGS:After oral diclofenac application, large interindividual differences in plasma concentrations were observed (range <3-4604 nm). Topical diclofenac application did not result in relevant systemic diclofenac levels (range 5-75 nm). MRI showed a significant reduction of renal perfusion in individuals with diclofenac levels ≥225 nm (baseline: 347 ± 7 vs diclofenac: 323 ± 8 ml/min/100 g, P < 0.01); no significant differences were observed in participants with diclofenac levels <225 nm. Diclofenac levels correlated negatively with thromboxane B2 levels pointing towards target engagement. CONCLUSIONS:Single-dose diclofenac caused a decrease in renal perfusion in participants with diclofenac levels ≥225 nm. We demonstrated that even a single dose of diclofenac can impair renal perfusion, which could be detrimental in patients with underlying chronic kidney disease or acute kidney injury.

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Hellms, S., Gueler, F., Gutberlet, M., Schebb, N.H., Rund, K., Kielstein, J.T., VoChieu, V., Rauhut, S., Greite, R., Martirosian, P., Haller, H., Wacker, F., Derlin, K., 2019. Single-dose diclofenac in healthy volunteers can cause decrease in renal perfusion measured by functional magnetic resonance imaging. journal of pharmacy and pharmacology 71, 1262–1270. https://doi.org/10.1111/jphp.13105
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