Recurrent Nephrotic Syndrome Induced by Nonsteroidal Anti-inflammatory Drugs

A 78-year-old male with a history of hypertension for 7 years, on regular treatment, with paroxysmal atrial fibrillation and hyperlipidemia was admitted into the urologic ward in June 2000 because of acute urine retention secondary to benign prostate hyperplasia (BPH). His usual medication included metoprolol, simvastatin and perindopril, which was changed to candesartan after admission. His serum creatinine level was about 130 mol/L in 1998 but had risen to around 180 mol/L on admission. Serum albumin was noted to be 25 g/L only. Terazosin, and subsequently doxazosin, was prescribed for the urine retention, but without much improvement. Transurethral resection of the prostate (TURP) was performed on 19 July 2000. Twenty-four hour urine collection 5 days after surgery documented proteinuria of 7.1 g/day. However, he was discharged without further investigations. Two months later, he was admitted again because of urinary tract infection with significant proteinuria. His serum creatinine was around 160 mol/L, and ultrasound of the kidneys showed normal-sized kidneys (left, 11.1 cm; right, 9.8 cm). Immune markers revealed negative results for anti-nuclear factor, anti-glomerular basement membrane antibody, and anti-neutrophil cytoplasmic antibodies. He had normal serum C3 and !"#$%&'kp^faë !"#$%&'()*+,&'-./012%34*56789