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Naproxen-induced nephropathy in systemic lupus erythematosus
B N Ling1, E Bourke, W G Campbell
1Department of Medicine, Emory University School of Medicine, Atlanta, Ga.
Nephron
|January 1, 1990
Summary
Systemic lupus erythematosus patients can develop kidney damage from nonsteroidal anti-inflammatory drugs (NSAIDs). This case highlights NSAID-induced nephropathy mimicking lupus nephritis, emphasizing the need for careful diagnosis and medication review.
Area of Science:
- Nephrology
- Rheumatology
- Pharmacology
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect multiple organs, including the kidneys.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain and inflammation management in SLE patients.
- NSAID-induced nephropathy is a potential complication, but its presentation can mimic other renal diseases.
Observation:
- A 34-year-old female with SLE presented with acute renal failure, nephrotic syndrome, and active urinary sediment.
- Initial clinical suspicion pointed towards lupus nephritis.
- Renal biopsy revealed chronic, active interstitial nephritis without immune deposits, but with diffuse foot process fusion in nonsclerotic glomeruli.
Findings:
- The renal biopsy findings were inconsistent with lupus nephritis and instead characteristic of nonsteroidal anti-inflammatory drug (NSAID)-induced nephropathy.
- This diagnosis was supported by the patient's history of intermittent naproxen use.
- This represents the first reported case of NSAID nephropathy occurring in a patient with systemic lupus erythematosus.
Implications:
- Discontinuation of NSAIDs and initiation of corticosteroid therapy led to significant improvement in renal function and remission of nephrotic syndrome.
- This case underscores the importance of considering NSAID nephropathy in SLE patients presenting with acute kidney injury, even with features suggestive of lupus nephritis.
- Accurate diagnosis through renal biopsy is crucial for appropriate management and preventing irreversible kidney damage in this vulnerable patient population.