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We report the cases of four patients with end-stage renal disease and New York Heart Association class III or IV heart failure of nonischemic origin as documented by coronary angiography. Because of left ventricular dysfunction (left ventricular end-diastolic pressure, 23 to 30 mm Hg; ejection fraction, 20% to 35%), all four patients were initially considered poor surgical candidates for renal transplantation. These same four patients became asymptomatic, however, with markedly improved cardiac function (ejection fraction, 43% to 69%) detected as early as 6 and 14 days after renal engraftment. Therefore, there exists a subset of patients with end-stage renal disease in whom congestive heart failure should not be considered a contraindication to renal transplantation. We conclude that some dialysis-dependent patients who manifest symptomatic heart failure of nonischemic origin have a reversible cardiomyopathy and should not be denied renal transplantation.

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We report a patient who presented with the classical features of fenoprofen-induced nephropathy. Initial response to a cessation of the drug and prednisone therapy was recovery of renal function, but proteinuria persisted. One year later, he experienced recurrence of the nephrotic syndrome with sustained renal failure. A clear progression from minimal-change lesions to focal glomerulosclerosis was shown in sequential renal biopsies. Not previously reported, this evolution is suggestive of the possibility that fenoprofen nephropathy may lead to chronic renal failure.