Successful management of steroid-resistant nephrotic syndrome using ibuprofen

We report the first case of the use of ibuprofen for the management of steroid-resistant nephrotic syndrome. A 41 year-old man with nephrotic syndrome, secondary to focal segmental glomerulosclerosis, had persistent nephrotic range proteinuria despite aggressive treatment with steroids and cyclophosphamide. His steroid-resistant nephrotic syndrome resolved rapidly when he was serendipituously started on ibuprofen for the treatment of pericarditis. His proteinuria remained low at about 0.5 g/day over the next two years of treatment with ibuprofen and without any increase in his serum creatinine. He did not receive any ACE inhibitor or calcium channel blocker. An attempt to discontinue ibuprofen resulted in the relapse of his nephrotic syndrome. Upon restarting ibuprofen, his proteinuria decreased to less than 0.5 g/day again. We conclude that ibuprofen has been effective and safe for the management of nephrotic syndrome in this patient. However, careful monitoring is prudent to assess the potential adverse effects of ibuprofen on renal function with prolonged use.