How do you approach the management of a patient with nonoliguric ESKD, massive proteinuria, and hypoalbuminemia who is already on an ACE inhibitor?

This situation does not come up often, but I think there should be serious consideration of attempting to decrease kidney function by measures such as NSAID administration. Severe proteinuria has detrimental effects way beyond any benefit one may obtain from preserving residual renal function. The p...

Yeah, it doesn’t come up very often, but ACE/ARB/NSAID are not very effective. Embolization may be the way to go.

Curious to understand if a cause of nephrotic syndrome would lead to a different approach. Especially where urine output is still preserved.

Specifically — for massive proteinuria and hypoalbuminemia in brittle diabetics — control of edema is all that is left and the risk of NSAIDs is just too high ...