sulindac and Nephrotic-Syndrome

Four elderly patients developed nephrotic syndrome while receiving sulindac. Sulindac treatment had commenced 4-12 months prior to presentation with the nephrotic syndrome. Two patients also developed oliguric renal failure. Renal biopsy in one showed minimal change nephropathy and in three cases membranous nephropathy. Interstitial nephritis was present on renal biopsy in all cases. The nephrotic syndrome and renal failure resolved in all cases after withdrawal of sulindac. Two patients received steroid therapy and improvement in renal function and disappearance of proteinuria seemed to be temporarily related to steroid therapy in both cases. Despite the fact that sulindac is less likely to cause renal failure due to inhibition of renal prostaglandin secretion this report shows that sulindac treatment can be associated with renal failure and the nephrotic syndrome.

Topics: Acute Kidney Injury; Aged; Aged, 80 and over; Female; Humans; Indenes; Male; Nephrotic Syndrome; Sulindac

Topics: Adult; Aged; Female; Humans; Kidney; Kidney Function Tests; Male; Middle Aged; Monitoring, Physiologic; Nephrotic Syndrome; Proteinuria; Sulindac

Seven salt depleted patients with the idiopathic nephrotic syndrome were treated with various non-steroidal anti-inflammatory drugs. Indomethacin, diclofenac-sodium and flurbiprofen decreased proteinuria, glomerular filtration rate, plasma renin activity and renal prostaglandin E2 excretion by 59%, 19%, 55% and 68% respectively. Sulindac induced no major changes in proteinuria, glomerular filtration rate, plasma renin activity and renal prostaglandin E2 excretion. The relative change in proteinuria and glomerular filtration rate during non-steroidal anti-inflammatory drug treatment correlated strongly with that of the renal prostaglandin E2 excretion (r = 0.89 and r = 0.70, respectively p less than 0.05). It is likely that the anti-proteinuric effect of non-steroidal anti-inflammatory drugs is dependent on their potency to inhibit renal prostaglandin synthesis and it is suggested that this effect is mediated by lowering transcapillary glomerular hydraulic pressure.

Topics: Adult; Anti-Inflammatory Agents; Diclofenac; Dinoprostone; Flurbiprofen; Glomerular Filtration Rate; Humans; Indomethacin; Male; Middle Aged; Nephrotic Syndrome; Prostaglandins E; Proteinuria; Renin; Sulindac

Topics: Female; Humans; Indenes; Middle Aged; Nephrotic Syndrome; Sulindac