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RPPEO Standards - Renal Impairment (Ketorolac)

Question# 505

In respects to the Ketorolac protocol, one of the contraindications is renal impairment. What is the definition, as per the RPPEO standards, of renal impairment? Is it a known pre existing disease process of the renal system or would it also include a UTI that has manifested into a potential kidney infection cause hematuria as a symptom? Would this hematuria then also be considered as an active bleed?


Ketorolac and ibuprofen are contraindicated in patients (1) with only one kidney; or (2) who have a known illness that impacts the filtration of blood, such as kidney failure or other chronic renal insufficiency.

Urinary tract infections typically do NOT cause significant impact on kidney filtration and therefore are NOT a renal impairment. Ketorolac or ibuprofen may, therefore, be administered.

UTI's and kidney stones are a known cause of hematuria.

  • Where a UTI or kidney stones are suspected and there are trace amounts of blood in the urine, ketorolac or ibuprofen may be administered for analgesia.
  • Gross (visible) hematuria should be considered a current active bleed and ketorolac and ibuprofen are contraindicated.
  • Where a UTI or kidney stones are strongly suspected and there is significant blood in the urine, consultation with the BHP to consider ketorolac or ibuprofen is recommended



23 February 2022



Please reference the MOST RECENT ALS PCS for updates and changes to these directives.