Abstract
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 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.
Original language | English (US) |
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Pages (from-to) | 1012-1017 |
Number of pages | 6 |
Journal | American Journal of Kidney Diseases |
Volume | 62 |
Issue number | 5 |
DOIs | |
State | Published - Nov 2013 |
Externally published | Yes |
Keywords
- Membranous nephropathy
- immunoglobulin G4 (IgG4)
- nonsteroidal anti-inflammatory drugs
- phospholipase A receptor
ASJC Scopus subject areas
- Nephrology