scholarly journals Rifampicin-Associated Secondary Minimal Change Disease Presenting with Nephrotic Syndrome in a Pulmonary Tuberculosis Patient

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Satyanand Sathi ◽  
Anil Kumar Garg ◽  
Manoj Kumar Singh ◽  
Virendra Singh Saini ◽  
Devinder Vohra

Various extraglomerular disease processes have been associated with drug-induced secondary minimal change disease (MCD). In a majority of cases, preferably, a hypersensitivity reaction appears to be involved, and in some cases, there is direct toxic effect over glomerular capillaries. There are several reports to demonstrate that rifampicin has been associated with various nephrotoxic adverse effects, but rifampicin-induced secondary minimal change disease (MCD) is very rare. Here, we report the case of a young adult male who presented with nephrotic proteinuria with bland urine sediment after one month of initiation of rifampicin treatment for pulmonary tuberculosis. The patient had no proteinuria before the start of antituberculosis treatment. Renal biopsy showed nonproliferative glomerulopathy and immunofluorescence did not show significant glomerular immune deposits. Electron microscopy showed diffuse effacement of visceral epithelial cell foot processes and did not show any presence of glomerular immune complexes and thickening of glomerular basement membrane, promoting the diagnosis of minimal change nephrotic syndrome. The patient got complete remission after discontinuation of rifampicin.

2021 ◽  
Vol 7 (1) ◽  
pp. e12-e12
Author(s):  
Erica E Faure ◽  
Jorge H. Mukdsi

Non-steroidal anti-inflammatory drugs (NSAIDs) have been used in the management of inflammatory disease for decades. The spectrum of nephrotoxicity attributed to NSAIDs includes mainly acute tubulointerstitial nephritis. However, much less attention has been given to drug-induced glomerular injury. NSAIDs treating patients presenting with nephrotic syndrome may have a variety of glomerular changes indistinguishable from those found in idiopathic minimal change disease (MCD), for example. The clinical presentation is typically abrupt with nephrotic syndrome while in the elderly it can present as acute renal failure from the beginning. We present an MCD-NSAID induced in elderly patient and discuss possible pathogenic mechanism, thinking about on the indiscriminate use of NSAIDs. Here we report the case of a 66-year-old woman with a history of nephrotic syndrome and hypertension without an apparent secondary etiology. However, an exhaustive history showed and indiscriminate use of NSAIDs. Renal biopsy showed a MCD with a mild interstitial nephritis. To our knowledge the morphology of drug-induced diseases often does not differ from the primary forms, making the distinction difficult. There are subtle clues, although the dialogue between clinician and pathologist is essential to reach an etiological diagnosis. Physicians should suspect glomerulonephritis in patients who receive drugs and its management must be determined based on the histological characteristics of the disease. Although corticosteroid therapy seems to be of value, the effectiveness of this approach must still be tested in randomized and multicentric clinical trials.


2017 ◽  
Vol 13 (1) ◽  
pp. 51-55
Author(s):  
Farhana Jalil ◽  
Mohammed Hanif ◽  
Golam Muin Uddin ◽  
Shireen Afroz

Introduction: Idiopathic nephrotic syndrome (INS) is the most common glomerular disorder of childhood. Clinical outcome of children with nephrotic syndrome depends on underlying histopathlogy and responsiveness to steroid treatment. Minimal change disease (MCD) has a favorable long-term prognosis whereas, other than minimal change nephrotic syndrome is often resistant to steroid and is more likely to progress to end-stage renal disease (ESRD). Neutrophil gelatinase-associated lipocalin (NGAL) which is a small protein belonging to the lipocalin superfamily has been demonstrated to be a powerful risk marker of chronic kidney disease progression. This study was undertaken to determine whether urinary NGAL could be used as a biomarker in differentiating minimal change disease from other glomerular histologic lesions in idiopathic nephrotic syndrome in children. Objectives: To evaluate the association between urinary NGAL and histological pattern in idiopathic nephrotic syndrome. Materials and Methods: This cross-sectional, multicenter study was conducted in the Department of Paediatric Nephrology, Dhaka Shishu Hospital and Department of Paediatric Nephrology, Bangabandhu Sheikh Mujib Medical University from June 2014 to May 2015. Fifty-one children with idiopathic nephrotic syndrome comprising 12 children with minimal change disease (MCD) and 39 with other than minimal change nephrotic syndrome were included. Urinary NGAL was measured using a commercially available HUMAN NGAL/ LIPOCALIN 2 ELISA kit which employed the quantitative sandwich enzyme immunoassay technique. Median urinary NGAL level were compared between MCD and other than MCD. Median urinary NGAL and urinary creatinine ratio also compared between two groups. The prognostic accuracy of urinary NGAL was assessed by receiver operating characteristic (ROC) curve analysis. Results: Median urinary NGAL (uNGAL) level of MCD group was 44.5 [IQR: 32-109.5] (ng/ml) and that of the other than MCD group was 130 [IQR:85-172] (ng/ml). This difference was statistically significant (p=0.004). Median urine NGAL and urine creatinine ratio was significant between two groups (MCD=105.5 ng/mg and other than MCD=288 ng/mg, p-value was<0.001). The area under the curve (AUC) for the uNGAL as a biomarker to differentiate MCD from other than MCD was 0.78 [95% CI: 0.64-0.92] (p=0.004) and showed an optimized sensitivity of 0.82 and specificity of 0.75 with an optimal trade-off value of 72 ng/ml. Conclusion: Urinary NGAL was found to be a reliable biomarker to differentiate the histological pattern in idiopathic nephrotic syndrome. Journal of Armed Forces Medical College Bangladesh Vol.13(1) 2017: 51-55


2000 ◽  
Vol 15 (7) ◽  
pp. 1056-1059 ◽  
Author(s):  
Keisuke Kohno ◽  
Yoshihiko Mizuta ◽  
Tomoyo Yoshida ◽  
Hisashi Watanabe ◽  
Hidemi Nishida ◽  
...  

2006 ◽  
Vol 65 (03) ◽  
pp. 203-207 ◽  
Author(s):  
T.H. Westhoff ◽  
R. Waldherr ◽  
C. Loddenkemper ◽  
W. Ries ◽  
W. Zidek ◽  
...  

2011 ◽  
Vol 45 (2) ◽  
pp. 179-185
Author(s):  
Hideyo Oguchi ◽  
Marohito Murakami ◽  
Takashi Araki ◽  
Mariko Meguro ◽  
Akinori Hashiguchi ◽  
...  

2021 ◽  
pp. 1753495X2199021
Author(s):  
Priyanka S Sagar ◽  
Eddy Fischer ◽  
Muralikrishna Gangadharan Komala ◽  
Bhadran Bose

Nephrotic syndrome presenting in pregnancy is rare and poses a diagnostic and therapeutic challenge. Timing of renal biopsy is important given the increased risk of bleeding and miscarriage, and the choice of immunosuppression is limited due to the teratogenicity profiles of standard drugs. We report and discuss a case of minimal change disease diagnosed by renal biopsy during early pregnancy and treated with corticosteroids throughout the pregnancy. Prompt diagnosis and treatment of glomerular disease in pregnancy are vital to prevent poor maternal and fetal outcomes.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Takaya Ozeki ◽  
Shoichi Maruyama ◽  
Toshiyuki Imasawa ◽  
Takehiko Kawaguchi ◽  
Hiroshi Kitamura ◽  
...  

AbstractFocal segmental glomerulosclerosis (FSGS) is a serious condition leading to kidney failure. We aimed to investigate the clinical characteristics of FSGS and its differences compared with minimal change disease (MCD) using cross-sectional data from the Japan Renal Biopsy Registry. In Analysis 1, primary FSGS (n = 996) were stratified by age into three groups: pediatric (< 18 years), adult (18–64 years), and elderly (≥ 65 years), and clinical characteristics were compared. Clinical diagnosis of nephrotic syndrome (NS) was given to 73.5% (97/132) of the pediatric, 41.2% (256/622) of the adult, and 65.7% (159/242) of the elderly group. In Analysis 2, primary FSGS (n = 306) and MCD (n = 1303) whose clinical diagnosis was nephrotic syndrome (NS) and laboratory data were consistent with NS, were enrolled. Logistic regression analysis was conducted to elucidate the variables which can distinguish FSGS from MCD. On multivariable analysis, higher systolic blood pressure, higher serum albumin, lower eGFR, and presence of hematuria associated with FSGS. In Japanese nationwide registry, primary FSGS patients aged 18–64 years showed lower rate of NS than those in other ages. Among primary nephrotic cases, FSGS showed distinct clinical features from MCD.


2012 ◽  
Vol 28 (5) ◽  
pp. 1225-1232 ◽  
Author(s):  
T. Takei ◽  
M. Itabashi ◽  
T. Moriyama ◽  
C. Kojima ◽  
S. Shiohira ◽  
...  

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