Cyclooxygenase-2 inhibitor-associated minimal-change disease

Area of Science:

• Nephrology
• Pharmacology
• Internal Medicine

Background:

• Selective cyclooxygenase-2 (COX-2) inhibitors offer anti-inflammatory and analgesic benefits with reduced gastrointestinal risks compared to nonselective NSAIDs.
• However, data on the non-gastrointestinal toxicity, particularly nephrotoxicity, of COX-2 inhibitors remain limited.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) are known for nephrotoxic effects, including minimal-change disease (MCD) with interstitial nephritis.

Observation:

• This report details a case of MCD and acute tubular necrosis (ATN) in a patient treated with celecoxib, a COX-2 inhibitor.
• Unlike a previous report, this case did not involve interstitial nephritis.
• While proteinuria resolved after celecoxib discontinuation, renal function did not fully recover.

Findings:

• Celecoxib, a selective COX-2 inhibitor, can induce minimal-change disease and acute tubular necrosis.
• Renal function may not recover completely even after drug withdrawal.
• This adverse renal effect highlights potential risks beyond the gastrointestinal tract.

Implications:

• Heightened clinical suspicion for COX-2 inhibitor-induced nephrotoxicity is warranted in patients presenting with nephrotic syndrome.
• Further research is needed to fully elucidate the spectrum of renal adverse effects associated with COX-2 inhibitors.
• This case underscores the importance of monitoring renal function in patients receiving selective COX-2 inhibitors.