Membranous nephropathy and nonsteroidal anti-inflammatory agents

FA Nawaz, CP Larsen, ML Troxell - American journal of kidney diseases, 2013 - Elsevier
FA Nawaz, CP Larsen, ML Troxell
American journal of kidney diseases, 2013Elsevier
Membranous nephropathy presents clinically as nephrotic syndrome, with subepithelial
immune complex deposits seen on biopsy. Historically, in about three-quarters of
membranous cases, no obvious etiologic agent or condition can be identified. More recently,
serum antibodies to the phospholipase A 2 receptor have been discovered in many patients
with primary/idiopathic membranous nephropathy. About one-quarter of patients have
membranous nephropathy as a manifestation of another systemic disorder, such as …
Membranous nephropathy presents clinically as nephrotic syndrome, with subepithelial immune complex deposits seen on biopsy. Historically, in about three-quarters of membranous cases, no obvious etiologic agent or condition can be identified. More recently, serum antibodies to the phospholipase A2 receptor have been discovered in many patients with primary/idiopathic membranous nephropathy. About one-quarter of patients have membranous nephropathy as a manifestation of another systemic disorder, such as autoimmune conditions, infection, malignancy, toxin exposure, or drugs (classically gold or penicillamine). In this report, we present a case of recurrent nephrotic syndrome with biopsy-proven membranous nephropathy closely associated with use of the nonsteroidal anti-inflammatory drugs (NSAIDs) naproxen and piroxicam. Characterization of the immunoglobulin G (IgG) subclass profile of the deposits showed abundant IgG1, weak IgG4, and positive staining for phospholipase A2 receptor. This case serves to highlight membranous nephropathy as an under-recognized renal complication of NSAID use. Other kidney effects of NSAIDs, such as hemodynamic compromise, interstitial nephritis, and minimal change disease, are more broadly recognized.
Elsevier