Minimal change glomerulopathy associated with nonsteroidal antiinflammatory drugs

Of 55 patients with adult onset minimal change glomerulopathy (MCG) studied at our center between 1971 and 1986, five (9%) had an association with the use of nonsteroidal antiinflammatory drugs (NSAIDs). All of the patients were female, and their mean age at the time of diagnosis was 57.4 +/- 11 (SD) (range 47 to 71) years. They had received NSAIDs for an average of 6.9 +/- 6.4 (range, 3 to 18) months before developing proteinuria. The presenting 24-hour urine protein was 11.3 +/- 10.2 (range, 2.1 to 24) g and all patients were hypoalbuminemic (serum albumin less than 3.5 g/dL) with edema. Two patients presented with acute renal insufficiency (serum creatinine greater than or equal to 1.3 mg/dL). Histologically, three patients had MCG associated with interstitial nephritis, and two had no evidence of interstitial disease. All five patients achieved a complete remission after discontinuing the NSAIDs. The remission occurred within 15 days for 80% of patients. A mean follow-up of 6.4 +/- 3.9 (range, 1.3 to 10.5) years was obtained on the patients. At the time of last follow-up, all patients had remained in complete remission, and all patients had normal renal function. Our experience confirms that MCG may present with or without interstitial nephritis. Once the NSAID is discontinued, a complete remission can be expected.