The effects of nonsteroidal anti-inflammatory drugs on glomerular filtration of proteins and their therapeutic utility

Cyclooxygenase inhibitors have long been used in experimental studies as well as in clinical practice to reduce urinary protein excretion in proteinuric renal diseases. However, the mechanisms by which this treatment limits glomerular filtration of proteins are not fully elucidated. We will review the cellular and molecular mechanisms that regulate glomerular permselectivity and the experimental observations available on the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on these glomerular functions. The effects of NSAIDs on glomerular microcirculation will also be analyzed in comparison with another class of drugs used to lower proteinuria in nephrotic patients, the angiotensin converting enzyme inhibitors. Finally, we will analyze the relationship between urinary prostaglandins and thromboxane A2 and discuss the effects of modulating these hormones on glomerular functions.