Sulindac and Renal Impairment-Reply

Abstract

In Reply.— The patient described by Whelton et al manifests both interstitial nephritis and nephrotic syndrome most likely caused by sulindac. This occurred after 36 months of treatment and resolved over several months after the drug therapy was discontinued. In our article, we noted four major types of renal toxicity on NSAID therapy: interstitial nephritis, minimal-change glomerulopathy, papillary necrosis, and functional changes in renal blood flow and glomerular filtration rate secondary to inhibition of prostaglandin synthesis. The first three types are rare, occur after weeks or months of NSAID therapy, and take extended periods to resolve. The mechanism in the first two types seems to be immunologically mediated, with lymphocytes playing a major role. 1,2 The combined presence of interstitial nephritis and minimalchange glomerulopathy in the patient of Whelton and co-workers is a characteristic of NSAID nephropathy. The renal toxicity emphasized in our article appears within several days, is frequently