Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Associated with NELL1-Positive Membranous Glomerulopathy

Introduction: Membranous nephropathy (MN) is the leading cause of nephrotic syndrome in adults. We are presenting a rare case of neural epidermal growth factor-like 1 (NELL-1) caused by NSAIDs. Case Description: A 49-year-old male with history of hyperlipidemia, DJD and on chronic NSAIDs admitted with complaints of periorbital swelling and generalized body swelling since 2 weeks. Also weight gain of 10 pounds over the last few weeks. h/o recent URI symptoms that resolved quickly. he is taking meloxicam for chronic foot pain and also started taking Artri King for last 2 weeks. vitals were with in acceptable range. on room air. exam shows 1-2+ edema. Labs showed serum Cr of 1.68, nephrotic range proteinuria with random UP/UC ratio 9.52, COVID-19 positive. rest of the labs were acceptable. Biopsy showed Membranous Glomerulopathy, NELL1-Positive. With supportive care, creatinine was 1.05 mg/dl and up/uc is 0.06. Discussion: NELL1-associated MN is commonly described with malignancy. Our case showed that NSAIDs also contribute for this target antigen associated MN. With in 1-2 months, patient better significantly with supportive care. There is an FDA alert on this Over the counter drug. Need to educate all providers in community not to use Artri King.Ig G1-2 +