REVERSIBLE MEMBRANOUS NEPHROPATHY ASSOCIATED WITH THE USE OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS

Objective.-To investigate the frequency of membranous nephropathy asso ciated with nonsteroidal anti-inflammatory drug (NSAID) use and identi fy associated clinical characteristics. Design.-Retrospective chart re view. Setting.-A large group practice that staffs 2 large teaching hos pitals. Patients.-All patients diagnosed as having stage I or early st age II membranous nephropathy by renal biopsy between January 1975 and May 1995. Main Outcome Measures.-Nephrotic syndrome was said to be as sociated with NSAID use if patients developed nephrotic syndrome while taking an NSAID and if other causes of membranous nephropathy were ex cluded and a rapid remission of the nephrotic syndrome followed withdr awal of the drug. Results.-Of 125 patients identified with early membr anous nephropathy, 29 were taking NSAIDs at the time symptoms of nephr otic syndrome developed. Thirteen of these patients met the criteria f or NSAID-associated membranous nephropathy. None of these patients had any evidence of renal insufficiency or significant proteinuria after follow-up periods ranging from 5 months to 13 years. In addition to di clofenac and fenoprofen, which have previously been implicated, ibupro fen, nabumetone, naproxen, and tolmetin were found to be associated. C onclusions.-Nephrotic syndrome due to membranous nephropathy should be recognized as an idiosyncratic drug reaction to many NSAIDs. Because withdrawal of the drug may result in prompt and complete recovery of n ormal renal function, a history of NSAID intake should be sought in pa tients with membranous nephropathy.