Is aceclofenac (Non-Steroidal Anti-Inflammatory Drug (NSAID)) contraindicated in IgA (Immunoglobulin A) nephropathy?

Aceclofenac is Contraindicated in IgA Nephropathy

Aceclofenac, as an NSAID, is contraindicated in patients with IgA nephropathy due to its potential to worsen kidney function and interfere with recommended treatments for this condition. 1

Rationale for Contraindication

• NSAIDs like aceclofenac can worsen kidney function in patients with glomerular diseases, particularly in those with already compromised renal function 1
• NSAIDs interfere with the beneficial effects of ACE inhibitors and ARBs, which are cornerstone therapies for IgA nephropathy 1
• NSAIDs may increase proteinuria, which is a key marker of disease progression in IgA nephropathy 1
• NSAIDs can cause acute kidney injury, especially in patients with pre-existing kidney disease 1

Management Approach for IgA Nephropathy

First-line Treatment: Supportive Care

• Optimized supportive care is the primary focus of IgA nephropathy management 1
• RAS blockade with ACE inhibitors or ARBs should be instituted for all patients with proteinuria >0.5 g/d, regardless of hypertension status (Grade 1B) 1
• Blood pressure targets should be <130/80 mmHg for patients with proteinuria <1 g/d and <125/75 mmHg for those with proteinuria >1 g/d 1
• Proteinuria reduction to under 1 g/d is a surrogate marker of improved kidney outcomes and a reasonable treatment target 1

High-Risk Patients

• Patients with persistent proteinuria >1 g/d despite 3 months of optimized supportive care are considered high-risk for progression 1
• For these patients, a 6-month course of glucocorticoid therapy may be considered if eGFR is >50 ml/min/1.73 m² (Grade 2B) 1
• Immunosuppressive therapy should be avoided in patients with eGFR <30 ml/min/1.73 m² unless there is rapidly progressive IgA nephropathy 1

Special Situations

• Crescentic IgA nephropathy (>50% of glomeruli with crescents) with rapidly deteriorating kidney function should be treated with cyclophosphamide and glucocorticoids 1, 2
• Patients with mesangial IgA deposition and minimal change disease features should be treated according to minimal change disease guidelines 1

Medications to Avoid in IgA Nephropathy

• NSAIDs (including aceclofenac) - can worsen kidney function and increase proteinuria 3, 4
• Nephrotoxic agents - should be avoided to prevent further kidney damage 3
• Non-recommended immunosuppressives for standard IgA nephropathy:
  • Azathioprine (except after cyclophosphamide in crescentic disease) 1
  • Cyclophosphamide (except in rapidly progressive disease) 1
  • Calcineurin inhibitors 1
  • Rituximab 1
  • Mycophenolate mofetil (except possibly in Chinese patients) 1

Emerging Therapies

• Newer therapies being evaluated include:
  • SGLT2 inhibitors 1, 5
  • Sparsentan 1, 5
  • Enteric-coated budesonide 1, 5
  • Complement inhibitors 1, 5
  • B-cell targeting therapies 1, 5

Clinical Pitfalls to Avoid

• Failing to optimize RAS blockade before considering immunosuppression 1, 6
• Using NSAIDs like aceclofenac for pain management in IgA nephropathy patients 3, 4
• Not monitoring for proteinuria reduction as a surrogate marker of treatment success 1
• Overlooking the importance of blood pressure control as part of supportive care 1, 6
• Initiating immunosuppressive therapy in patients with eGFR <30 ml/min/1.73 m² (unless rapidly progressive disease) 1