From the Guidelines
Proteinuria can be caused by several medications, including dihydropyridine calcium channel blockers, which may exacerbate edema and increase proteinuria, as noted in the 2023 study 1.
Medications Causing Proteinuria
The following medications are known to cause proteinuria:
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and diclofenac, which can impair renal blood flow and cause protein leakage
- Antibiotics such as penicillins, cephalosporins, and sulfonamides, which may induce immune-mediated kidney injury leading to proteinuria
- Chemotherapeutic agents like cisplatin and methotrexate, which can directly damage kidney structures
- Gold compounds and penicillamine used for rheumatoid arthritis, which often cause membranous nephropathy with significant protein loss
- ACE inhibitors and ARBs, which, while typically renoprotective, can occasionally cause proteinuria, especially at high doses, as mentioned in the 2014 study 1
- Lithium used for bipolar disorder, which may induce nephrotic syndrome with prolonged use
- Proton pump inhibitors like omeprazole, which have been associated with acute interstitial nephritis and subsequent proteinuria
Mechanism of Proteinuria
The mechanism of proteinuria typically involves either direct toxicity to kidney structures, immune-mediated damage, or alterations in renal hemodynamics, as discussed in the 2014 study 1.
Management of Proteinuria
Discontinuation of the offending medication is usually the first step in managing proteinuria, as noted in the 2023 study 1. In some cases, substitution with another antihypertensive agent may be necessary, as mentioned in the 2023 study 1. It is essential to monitor kidney function and adjust medication regimens accordingly to prevent further kidney damage, as recommended in the 2014 study 1.
From the FDA Drug Label
Grades 2 to 3 proteinuria (2 to 4+) and/or glycosuria (3+) occurred in less than 1% of subjects treated with emtricitabine and tenofovir disoproxil fumarate tablets in the iPrEx trial and Partners PrEP trial. The medication tenofovir can cause proteinuria (excess protein in the urine) in some patients, with an incidence of less than 1% in clinical trials 2.
- Key points:
- Proteinuria was observed in less than 1% of subjects treated with tenofovir.
- The incidence of proteinuria was higher in the tenofovir treatment group compared to the placebo group.
From the Research
Medications Causing Proteinuria
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause proteinuria, as they affect renal blood flow and glomerular filtration rate 3, 4, 5, 6
- Specific NSAIDs that have been associated with proteinuria include:
- The mechanism of NSAID-induced proteinuria is thought to be related to the inhibition of prostaglandin synthesis, which can lead to a decrease in renal blood flow and glomerular filtration rate 4, 7, 5
- In some cases, NSAID use can also lead to interstitial nephritis, which can cause proteinuria and renal failure 6