Glomerulonephritis NSAIDs

The nonsalicylate NSAIDs can also affect renal function. Risk factors fc>r NSAID-induced acute renal failure include congestive heart feilure, glomerulonephritis, chronic renal insufficiency, cirrhosis, systemic lupus erythematosus, diabetes mellitus, significant atherosclerotic disease in the elderly and use of diuretics. NSAIDs can adversely affect cardiovascular homeostasis and can be a risk factor for the onset or exacerbation of heart feilure. 

Like many other NSAIDs, ketoprofen can cause acute interstitial nephritis (10). Renal insufficiency and the nephrotic syndrome due to membranous glomerulonephritis (an unusual cause of NSAID-induced nephrotic syndrome) have been described in an elderly patient taking long-term ketoprofen (SEDA-12, 86). 

NSAID induced nephrotic syndrome is suspected of being immunologically mediated and idiosyncratic. It has a distinct presentation when compared to that ascribed to acute interstitial nephritis. The nephrotic syndrome is not associated with hemodynamically stressed patients. Recently Radford etal. [%] published a retrospective study of NSAIDs induced membranous nephropathy using the Mayo Clinic biopsy registry. They reported that >10% of biopsy proven membranous glomerulonephritis [stage I/II] was attributable to NSAIDs. They summarized the clinical features of... 

Patients with chronic parenchymal renal disease show a fall in RBF and GFR during treatment with NSAID, including aspirin . In chronic glomerulonephritis, afferent arteriolar dilatation may be a compensatory mechanism in the maintenance of filtration. A study of patients with systemic lupus erythematosus revealed an abnormal increase in basal PGE2 excretion consistent with the postulated means of compensation. In other aetiologies of renal insufficiency, including diabetes, hypertension and interstitial nephritis, there is acute worsening of renal function with NSAID " ... 

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