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Published on: August 23, 2024
Membranous nephropathy and nonsteroidal anti-inflammatory agents
Fareha A Nawaz1, Christopher P Larsen, Megan L Troxell
1Willamette Valley Medical Center, McMinnville, OR.
Summary
Membranous nephropathy, a cause of nephrotic syndrome, can be linked to nonsteroidal anti-inflammatory drug (NSAID) use. This case highlights NSAID-associated membranous nephropathy, an under-recognized kidney complication.
Area of Science:
- Nephrology
- Immunology
- Pharmacology
Background:
- Membranous nephropathy (MN) is a leading cause of nephrotic syndrome in adults.
- Idiopathic MN is often associated with phospholipase A2 receptor (PLA2R) antibodies.
- Secondary MN can result from infections, autoimmune diseases, malignancies, or drug exposure.
Observation:
- A case of recurrent nephrotic syndrome with biopsy-proven MN is presented.
- The patient's MN was strongly associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs), specifically naproxen and piroxicam.
- Immune deposits in the kidney biopsy showed abundant IgG1, weak IgG4, and positive staining for PLA2R.
Findings:
- This case suggests a potential causal link between NSAID use and the development of membranous nephropathy.
- The IgG subclass profile and PLA2R staining in this NSAID-associated MN case resemble those seen in idiopathic MN.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are identified as an under-recognized cause of membranous nephropathy.
Implications:
- Clinicians should consider NSAID-induced nephrotoxicity when evaluating patients with membranous nephropathy.
- Further research is warranted to elucidate the mechanisms underlying NSAID-associated MN.
- Recognizing NSAIDs as a potential trigger for MN may improve patient outcomes by enabling timely drug withdrawal.
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