Prostaglandin inhibitors in the treatment of nephrotic syndrome.

The management of nephrotic syndrome resistant to corticosteroid and cytotoxic therapy is unclear. In such patients, prostaglandin inhibitors can reduce proteinuria. Mechanisms may include a reduction in transcapillary hydraulic pressure and a decrease in capillary wall permeability. The antiproteinuric effect of these agents is enhanced by volume depletion induced by sodium restriction and thiazide diuretics. Complications may include aggravation of edema, hemodynamic renal failure, hyperkalemia, and drug nephrotoxicity. Although a reduction in protein excretion may improve the clinical status of nephrotic patients, it is unclear whether such methods will improve renal survival.