Proteinuria NSAIDs

Potassium-sparing diuretics may cause hyperkalemia, especially in patients with chronic kidney disease or diabetes, and in patients receiving concurrent treatment with an ACE inhibitor, ARB, NSAID, or potassium supplement. Eplerenone has an increased risk for hyperkalemia and is contraindicated in patients with impaired renal function or type 2 diabetes with proteinuria. Spironolactone may cause gynecomastia in up to 10% of patients, but this effect occurs rarely with eplerenone. 

Targeting of nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen could be of interest for the treatment of proteinuria and tubular defects such as Fanconi syndrome and Bartter s syndrome [73,74]. Although a conjugate with an ester spacer is preferred to a conjugate with a direct peptide hnkage [66,67], we continued our research using naproxen di-... 

Proteinuria/ Interstitial nephritis t recruitment and activation of lymphocytes, likely through leukotriene formation, affecting glomerular and peritubular permeability Fenoprofen use, possibly female gender, advanced age Discontinue NSAID, support with dialysis and steroids, if needed... 

NSAlD-induced AIN has a different clinical presentation than that seen with most other drugs. Patients are typically over age 50 (reflecting NSAID use for degenerative joint disease), the onset is delayed a mean of 6 months from initiation of therapy, and ex-trarenal symptoms are observed in only 10% of patients. Concomitant nephrotic syndrome (proteinuria >3.5 g/day) occurs inmorethan70% of patients. Eenoprofen-allergic interstitial nephritis is considered the prototype for NSAlD-induced AIN because it accounts for nearly 50% of cases. ... 

Indometacin has been found to increase the AUC of penicillamine by 26% and the peak plasma levels by about 22%. The UK manufacturer notes that use of NSAIDs may increase the risk of renal damage with penicillamine. The US manufacturer specifically recommends avoiding oxy-phenbutazone or phenylbutazone because these drugs are also associated with serious haematological and renal effects. Urinalysis for detection of haematuria or proteinuria should be regularly carried out in patients taking penicillamine. Be alert for evidence of toxicity if NSAIDs and penicillamine are used together. 

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