NSAIDs and Proteinuria
Could some of the hemodynamic effects of NSAIDs be harnessed for good? Angiotensin converting enzyme inhibitors reduce glomerular pressure by decreasing efferent arteriolar vasoconstriction mediated by angiotensin II. NSAIDs also reduce glomerular pressure, by reducing prostaglandin mediated afferent vasodilatation. Hence, NSAIDs do induce a similar antiproteinuric effect, which had been used in severe nephrotic syndrome before the advent of RAS blockade. There are intriguing data that NSAIDs, in particular indomethacin, lowers proteinuria further in patients already on RAS blockade. In addition, a small retrospective study of patients with well preserved kidney function and nephrotic syndrome reported improved renal survival with indomethacin. Given the concern with analgesic nephropathy, these findings have never been tested in a properly conducted prospective trial, but perhaps deserve to, in a carefully selected and monitored population.
Curr Opin Nephrol Hypertens. 2019;28(2):163-170. © 2019 Lippincott Williams & Wilkins