Membranous nephropathy and nonsteroidal anti-inflammatory agents

Fareha A. Nawaz, Christopher P. Larsen, Megan L. Troxell

Research output: Contribution to journalArticle

24 Scopus citations

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 languageEnglish (US)
Pages (from-to)1012-1017
Number of pages6
JournalAmerican Journal of Kidney Diseases
Volume62
Issue number5
DOIs
StatePublished - Nov 1 2013

Keywords

  • Membranous nephropathy
  • immunoglobulin G4 (IgG4)
  • nonsteroidal anti-inflammatory drugs
  • phospholipase A receptor

ASJC Scopus subject areas

  • Nephrology

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