"Certainly in the way NSAIDs affect the kidneys, it's reasonable to think that dehydration plus an NSAID has more of an effect than just an NSAID by itself," he said.

Often the signs of kidney problems aren't apparent, Misurac said. One sign is a decrease in urine; another is stomach pain. "But most kids who have episodes of acute kidney injury have nonspecific symptoms and there's no one way to tell," he said.

"If kids are dehydrated and not drinking well, then parents should think twice about using NSAIDs," Misurac said. Tylenol (acetaminophen), which acts differently than NSAIDs, might be a better choice for children, he said.

For many of the children in the study, the kidney damage was reversed, Misurac said. The damage, however, was permanent for seven patients and they will probably need ongoing monitoring and treatment for declining kidney function, he said.

All the children under age 5 had to undergo dialysis and were more likely to be treated in an intensive-care unit, the researchers said. They also stayed in the hospital longer.

Although the study showed an association between taking NSAIDs and kidney problems in children, it didn't establish a cause-and-effect relationship.

One expert agreed that NSAIDs can damage the kidneys.

"This is well known. Unfortunately, it is better known among doctors; the public is not as educated regarding this problem," said Dr. Felix Ramirez-Seijas, director of pediatric nephrology at Miami Children's Hospital.

Ramirez-Seijas said NSAIDs are "overused and abused, both by doctors and patients."

For children, most fevers should not be treated; fever is how the body fights infection, he said. "There is a fear of fever that leads to overtreatment," Ramirez-Seijas said.

In addition, children who take NSAIDs for aches after vigorous exercise also are at risk, beca
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