Renal side-effects of non-steroidal anti-inflammatory drugs (NSAID) can be divided into five clinical syndromes: (i) acute renal failure; (ii) acute interstitial nephritis with nephrotic syndrome; (iii) electrolyte and fluid disorders; (iv) hypertension; and (v) analgesic nephropathy. 1 We describe an unusual combination of minimal change disease (MCD) and acute tubular necrosis (ATN) caused by diclofenac.A 53-year-old woman with nephrotic syndrome and acute renal failure was admitted to our hospital. The patient's medical history was unremarkable except for nontreated hypertension for 5 years. The only medication was oral diclofenac for chronic muscular pain and knee arthropathy. The patient was pale, 83 kg of weight, with generalized oedema and blood pressure 130/80 mmHg. Ocular fundus showed hypertensive changes grade I/II. Erythrocyte sedimentation rate was 21 mm/h and white blood cells count 9 ¥ 10 9 /L without eosinophilia. Urine dipstick showed +++ protein. There were a few erythrocytes and leucocytes in the urine sediment, but no eosinophils. Protein urine excretion was 6.0 g/day and creatinine was 716 mmol/L. Total serum protein was 59 g/L and albumin 23 g/L. Light microscopy renal biopsy showed glomeruli with normal morphology. There was severe tubular injury ( Fig. 1). Arterioles showed mild to moderate hyaline arte-IRENA MAKULSKA, IZABELA MADER-WOŁYNSKA, DANUTA ZWOLINSKA
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