CONSULT ROUNDS

We discussed a case of NSAID induced glomerular disease. NSAIDS are a group of drugs that can effect the kidney in many ways possible. Besides the hemodynamic causes of renal injury from NSAIDS, there has been a strong association with Acute interstitial Nephritis.
Another interesting association of NSAIDS is AIN with nephrotic syndrome ( usually seen with membranous or Minimal Change disease) and patients present with frank nephrotic syndrome and even lympadenopathy sometimes.
What is the time from use to disease, usually around 1-2 months for AIN, but could be months or years even. It's been reported that membranous can be on average 39 months after using NSAIDS.
The degree of proteinuria was independent on the amount of immune deposits in the glomeruli. So even if you have two -three immune deposits, you might have membranous Stage I or II but may behave clinically like Minimal Change Disease. The pathology finding is swelling and allergic reaction and activation of lymphocytes.
The most important clinical pearl is that the renal function in AIN and glomerular disease with NSAIDS was strongly associated with the tubular interstitial changes more  and inversely related to the amount of immune deposits in the glomeruli.