title: Membranous nephropathy and nonsteroidal anti-inflammatory agents.
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 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.
authors.affiliation: Willamette Valley Medical Center, McMinnville, OR.
authors.forename: Fareha A
authors.initials: FA
authors.lastname: Nawaz
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Larsen
authors.forename: Megan L
authors.initials: ML
authors.lastname: Troxell
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D001416:Back Pain / Q000188:drug therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D015433:Glomerulonephritis, Membranous / Q000139:chemically induced* / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D009288:Naproxen / Q000009:adverse effects* / Q000627:therapeutic use; D020370:Osteoarthritis, Knee / Q000188:drug therapy; D010894:Piroxicam / Q000009:adverse effects* / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D013256:Steroids; D010894:Piroxicam; D009288:Naproxen; D003520:Cyclophosphamide
keywords: Membranous nephropathy; immunoglobulin G4 (IgG4); nonsteroidal anti-inflammatory drugs; phospholipase A(2) receptor