Nephrotic Syndrome and Acute Tubular Necrosis Due to Meloxicam Use

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used by patients all over the world. Five to eighteen percent of the patients who receive NSAIDs can suffer from kidney-related side effects. Among them, the most relevant are sodium and water retention, hyponatremia, worsening of hypertension or preexisting cardiac failure, hyperkalemia, acute kidney injury, chronic kidney disease, papillary necrosis, nephrotic syndrome (NS), and acute interstitial nephritis. We report the case of a 65-year-old woman who developed acute tubular necrosis and NS a few days after receiving 15 mg of meloxicam (MLX) for 3 days for tendinitis. Steroid therapy was begun with normalization of kidney function after 7 weeks of treatment. NS (minimal change disease) was characterized by frequent remissions and relapses as prednisone was lowered under 30 mg/day. Azathioprine (100 mg/day) was added on the fifth month of diagnosis and a complete remission was finally obtained 4 years after hospital admittance. In her last medical checkup, 8 years after her debut and receiving azathioprine (50 mg) and prednisone (5 mg/day), renal function was normal (creatinine 1.0 mg/dL and creatinine clearance 80 mL/min/1.73 m 2 ), proteinuria was 150 mg/day and there was no hematuria or hypertension. The aim of communicating this case is to raise a warning about these renal side effects of MLX. After thorough review of literature, only one other report with the same findings was found.

Risk of Nephrotic Syndrome for Non-Steroidal Anti-Inflammatory Drug Users

“…Our findings confirmed previous studies. Case reports and case series showed that NSAID-associated nephrotic syndrome occurs from the exposure duration of ,1 week (30,31) to years (17,32,33). Even further, nephrotic syndrome might develop 6 months after the discontinuation of an NSAID (34).…”

“…As a chemical mediator, PGs are essential for kidney hemodynamic including glomerular filtration. In nephrotic syndrome, glomeruli are impaired by the inflammation processes that allow proteins to pass through kidney cell membranes (30,36,37). Hypersensitivity mechanisms of NSAIDs for nephrotic syndrome are caused allegedly by the shift of PG synthesis from COX to lipoxygenase paths, or the release of lymphokines that increase the production of leukotrienes.…”

Non-steroidal anti-inflammatory drug effects on renal and cardiovascular function: from physiology to clinical practice

“…NSAIDs as a class (in particular propionic acid derivatives such as fenoprofen) (Table 1), including COX-2 selective drugs, can induce both AIN and a nephrotic syndrome associated with minimal change or membranous nephropathy. 52,53 A 30% rise of NSAID-mediated AIN cases is reported especially in elderly people, mainly because of polypharmacy. Nephrotic syndrome can occur in NSAID-mediated AIN but is rare (less than 1%).…”

Effect of Meloxicam on Hematological and Kidney Histopathological Changes in Male Mice

“…These changes were in the form of fusion of foot processes with focal obliteration of filtration slits resulting in massive proteinuria and hence hyaline casts were found in the renal tubules [2,11,15]. Jorge Vega et al, demonstrated that meloxicam causes tubulo-interstitial nephritis associated with proteinuria manifested histologically in the form of hyaline casts [16].…”