Minimal change disease associated with balsalazide therapy for ulcerative colitis

Introduction: 5-aminosalicylic acid (5-ASA) compounds have been used in the management of ulcerative colitis for decades. Nephrotoxicity has been previously described in patients treated with 5-ASA compounds and usually manifests as interstitial nephritis, however a few cases of nephrotic syndrome have been reported. Balsalazide is a pro-drug composed of 5-ASA linked to an inert carrier. Case Presentation: Here we report the case of a 74-year-old man with a history of ulcerative proctosigmoiditis treated with balsalazide who presented to our clinic with bilateral lower extremity edema three months after initiation of balsalazide. Laboratory workup showed nephrotic range proteinuria without an apparent secondary etiology. Given worsening proteinuria and renal function despite cessation of balsalazide, the patient underwent renal biopsy that revealed minimal change disease. High dose steroids were started and complete remission of proteinuria was achieved one month into therapy which was slowly tapered over the next five months. Eventual resolution of edema and return of creatinine back to patient’s baseline level was achieved. Conclusion: To our knowledge, this is the first report of nephrotic syndrome manifesting soon after initiation of balsalazide therapy. Our work highlights the importance of maintaining a high clinical suspicion for nephrotoxicity when using balsalazide.

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What about NSAID and secondary minimal change disease in adult’s people? A case report and review of the literature

Journal of Renal Endocrinology ◽

10.34172/jre.2021.12 ◽

2021 ◽

Vol 7 (1) ◽

pp. e12-e12

Author(s):

Erica E Faure ◽

Jorge H. Mukdsi

Keyword(s):

Nephrotic Syndrome ◽

Minimal Change Disease ◽

Clinical Presentation ◽

The Elderly ◽

Minimal Change ◽

Glomerular Injury ◽

Drug Induced ◽

History Of ◽

Histological Characteristics ◽

Inflammatory Drugs

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.

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Hodgkin Disease and Nephrotic Syndrome, a Rare Paraneoplastic Complication in Children with Literature Review

Blood ◽

10.1182/blood.v112.11.4832.4832 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4832-4832

Author(s):

Sehba Dsilva ◽

Gungor Karayalcin ◽

Sharon Singh

Keyword(s):

Nephrotic Syndrome ◽

Renal Biopsy ◽

Minimal Change Disease ◽

Pediatric Population ◽

Minimal Change ◽

Hodgkin Disease ◽

Humoral Factors ◽

History Of ◽

Work Up ◽

Nodular Sclerosing

Abstract The association between Hodgkin Disease (HD) and paraneoplastic Nephrotic Syndrome is well documented in adults but is relatively uncommon in the pediatric population. We describe two children with HD who initially presented with Nephrotic Syndrome. Case 1: 12- year-old boy who presented with a two-week history of periorbital edema, proteinuria and hypertension and was diagnosed with Nephrotic Syndrome. The renal biopsy showed minimal change disease. Since the patient developed dyspnea, further work-up was done and he was found to have a large mediastinal mass. Core needle biopsy of the mass was consistent with HD, nodular sclerosing type. Case 2: 14-year-old boy diagnosed to have Nephrotic Syndrome with biopsy proven minimal change disease and was treated intermittently with steroids over 6 months. He subsequently developed dyspnea and was found to have a right paratracheal mass and excisinal biopsy was consistent with HD, nodular sclerosing type. Both these patients initially presented with Nephrotic Syndrome which completely resolved after the first course of chemotherapy for HD. Upon review of literature, there have been 23 pediatric cases of Nephrotic Syndrome associated with HD in patients ranging in age between 2–15 years. The renal biopsy was not done for 8 of these patients and the diagnosis was established clinically. Fifteen patients had biopsies, 9 had minimal change disease, 1 mesangial hypercellularity, 1 glomerulosclerosis, 1 undetermined histology and 3 were normal. In all cases, the Nephrotic Syndrome was refractory to steroids and resolved with treatment of the HD. Pathogenesis of the Nephrotic Syndrome associated with HD is not known, however there are speculations about T-cell involvement and production of lymphokines and humoral factors which may be responsible for the glomerular damage.

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ITI with high-dose FIX and combined immunosuppressive therapy in a patient with severe haemophilia B and inhibitor

Hämostaseologie ◽

10.1055/s-0037-1617018 ◽

2009 ◽

Vol 29 (02) ◽

pp. 155-157 ◽

Cited By ~ 22

Author(s):

H. Hauch ◽

J. Rischewski ◽

U. Kordes ◽

J. Schneppenheim ◽

R. Schneppenheim ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Immunosuppressive Agents ◽

Tolerance Induction ◽

Intravenous Immunoglobulins ◽

Factor Ix ◽

High Dose ◽

Allergic Reactions ◽

Success Rates ◽

Serious Infections ◽

History Of

SummaryInhibitor development is a rare but serious event in hemophilia B patients. Management is hampered by the frequent occurrence of allergic reactions to factor IX, low success rates of current inhibitor elimination protocols and the risk of development of nephrotic syndrome. Single cases of immune tolerance induction (ITI) including immunosuppressive agents like mycophenolat mofetil (MMF) or rituximab have been reported. We present a case of successful inhibitor elimination with a combined immune-modulating therapy and high-dose factor IX (FIX). This boy had developed a FIX inhibitor at the age of 5 years and had a history of allergic reactions to FIX and to FEIBA→. Under on-demand treatment with recombinant activated FVII the inhibitor became undetectable but the boy suffered from multiple joint and muscle bleeds. At the age of 11.5 years ITI was attempted with a combination of rituximab, MMF, dexamethasone, intravenous immunoglobulins and high-dose FIX. The inhibitor did not reappear and FIX half-life normalized. No allergic reaction, no signs of nephrotic syndrome and no serious infections were observed.

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A case of minimal change disease during pregnancy – Benefits of early diagnosis and use of corticosteroids

Obstetric Medicine ◽

10.1177/1753495x21990214 ◽

2021 ◽

pp. 1753495X2199021

Author(s):

Priyanka S Sagar ◽

Eddy Fischer ◽

Muralikrishna Gangadharan Komala ◽

Bhadran Bose

Keyword(s):

Nephrotic Syndrome ◽

Early Diagnosis ◽

Renal Biopsy ◽

Early Pregnancy ◽

Minimal Change Disease ◽

Minimal Change ◽

Risk Of Bleeding ◽

Increased Risk ◽

Prompt Diagnosis ◽

In Pregnancy

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.

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Clinical manifestations of focal segmental glomerulosclerosis in Japan from the Japan Renal Biopsy Registry: age stratification and comparison with minimal change disease

Scientific Reports ◽

10.1038/s41598-020-80931-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Takaya Ozeki ◽

Shoichi Maruyama ◽

Toshiyuki Imasawa ◽

Takehiko Kawaguchi ◽

Hiroshi Kitamura ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Renal Biopsy ◽

Focal Segmental Glomerulosclerosis ◽

Clinical Diagnosis ◽

Clinical Characteristics ◽

Minimal Change Disease ◽

Multivariable Analysis ◽

Laboratory Data ◽

Minimal Change ◽

Segmental Glomerulosclerosis

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.

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Efficacy of 5-Aminosalicylic Acid Enemas in the Treatment of Distal Ulcerative Colitis

Canadian Journal of Gastroenterology ◽

10.1155/1990/314931 ◽

1990 ◽

Vol 4 (7) ◽

pp. 468-471 ◽

Cited By ~ 3

Author(s):

MG Robinson ◽

DL Decktor

Keyword(s):

Ulcerative Colitis ◽

Disease Activity ◽

Activity Index ◽

Disease Activity Index ◽

First Episode ◽

High Dose ◽

Aminosalicylic Acid ◽

Open Label ◽

Distal Ulcerative Colitis ◽

The Mean

The efficacy of 4 g 5-aminosalicylic acid (5-ASA, mesalamine) enemas was assessed in 666 patients with distal ulcerative colitis. Patients were enrolled in an open-label compassionate use program. One 4 g 5-ASA enema was administered each night for a period of four weeks and the disease activity index was assessed at baseline and on days 14 and 28. On days 14 and 28, 78.0% and 88.1% of patients, respectively, demonstrated an improvement in disease activity index. The mean decline in disease activity index on day 14 was 40.7% (P=0.0001) and on day 28 it was 55.4% (P=0.0001). Efficacy was similar whether the disease was confined to or extended beyond 30 cm from the anus. There was no difference in efficacy in patients suffering their first episode of disease compared to patients suffering subsequent attacks. In conclusion, high dose 5-ASA enemas are a highly effective treatment for distal ulcerative colitis.

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Minimal Change Disease as a Secondary and Reversible Event of a Renal Transplant Case with Systemic Lupus Erythematosus

Case Reports in Nephrology ◽

10.1155/2015/987212 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Elena Gkrouzman ◽

Kyriakos A. Kirou ◽

Surya V. Seshan ◽

James M. Chevalier

Keyword(s):

Systemic Lupus Erythematosus ◽

Nephrotic Syndrome ◽

Renal Transplant ◽

Transplant Recipient ◽

Lupus Erythematosus ◽

Minimal Change Disease ◽

Iliac Vein ◽

Minimal Change ◽

Systemic Lupus ◽

Vein Stenosis

Secondary causes of minimal change disease (MCD) account for a minority of cases compared to its primary or idiopathic form and provide ground for consideration of common mechanisms of pathogenesis. In this paper we report a case of a 27-year-old Latina woman, a renal transplant recipient with systemic lupus erythematosus (SLE), who developed nephrotic range proteinuria 6 months after transplantation. The patient had recurrent acute renal failure and multiple biopsies were consistent with MCD. However, she lacked any other features of the typical nephrotic syndrome. An angiogram revealed a right external iliac vein stenosis in the region of renal vein anastomosis, which when restored resulted in normalization of creatinine and relief from proteinuria. We report a rare case of MCD developing secondary to iliac vein stenosis in a renal transplant recipient with SLE. Additionally we suggest that, in the event of biopsy-proven MCD presenting as an atypical nephrotic syndrome, alternative or secondary, potentially reversible, causes should be considered and explored.

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Short-Term Steroid Regimen for Adult Steroid-Sensitive Minimal Change Disease

American Journal of Nephrology ◽

10.1159/000495352 ◽

2018 ◽

Vol 49 (1) ◽

pp. 54-63 ◽

Cited By ~ 2

Author(s):

Takaya Ozeki ◽

Takayuki Katsuno ◽

Hiroki Hayashi ◽

Sawako Kato ◽

Yoshinari Yasuda ◽

...

Keyword(s):

Nephrotic Syndrome ◽

Minimal Change Disease ◽

Minimal Change ◽

First Episode ◽

Short Term ◽

Short Term Treatment ◽

Steroid Dose ◽

Steroid Sensitive ◽

Steroid Regimen ◽

Frequent Relapse

Background: In pediatric patients with steroid-sensitive nephrotic syndrome, recent trials have revealed that a 2-month, short-term steroid regimen is not inferior to an extended steroid course. However, the optimal duration of initial steroid therapy for adult steroid-sensitive minimal change disease (MCD) remains unclear. Objectives: The aim of present study was to evaluate the effectiveness of a 2-month, short-term steroid regimen in the treatment of adult steroid-sensitive MCD patients. Method: This was a prospective observational study. Adult patients with steroid-sensitive MCD (n = 35) who were initiated on a short-term steroid regimen between January 2015 and June 2016 were included. The details of the regimen are as follows: (1) prednisolone was administered at an initial dose of 0.8–1.0 mg/kg/day and continued for 4–6 weeks and (2) dosage was reduced to 0.5–0.6 mg/kg/alternate day and continued for 4 weeks. Control patients (n = 140), who were treated using conventional steroid administration, were selected from our previous adult MCD cohort. All patients fulfilled the following criteria: biopsy-proven MCD, age ≥20 years, first episode of nephrotic syndrome, and attainment of complete remission within 4 weeks. The following parameters of patients who received short-term treatment regimen and control patients were compared: any relapse and frequent relapse, adverse events caused by steroid treatment and cumulative steroid dose. Results: Throughout the observation period (median: 17.3 months), 24 (68.6%) patients in the short-term group developed at least one relapse. The short-term regimen showed earlier occurrence of any relapse than the conventional regimen (adjusted hazard ratio [aHR] 2.45; 95% CI 1.51–3.97; p < 0.001), but there was no difference in frequent relapse (aHR 1.31; 95% CI 0.43–3.99; p = 0.63). None of the patients showed any symptoms of adrenal insufficiency after discontinuation of corticosteroids. The cumulative steroid dose during the observational period was significantly lower in the short-term group than in the conventional group. Conclusions: The short-term steroid regimen may represent an effective treatment option that ensures lower steroid exposure when treating adult steroid-sensitive MCD patients.

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Clinical Characteristics and Outcomes of Adults with Nephrotic Syndrome Due to Minimal Change Disease

Journal of Clinical Medicine ◽

10.3390/jcm10163632 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3632

Author(s):

Sophia Lionaki ◽

Evangelos Mantios ◽

Ioanna Tsoumbou ◽

Smaragdi Marinaki ◽

George Makris ◽

...

Keyword(s):

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Minimal Change Disease ◽

Kidney Injury ◽

Spontaneous Remission ◽

Minimal Change ◽

Adult Onset ◽

Potential Risk Factors ◽

The Mean ◽

End Stage

Purpose: Minimal change disease (MCD) is considered a relatively benign glomerulopathy, as it rarely progresses to end-stage kidney disease. The aim of this study was to describe the characteristics and outcomes of adults with MCD and identify potential risk factors for relapse. Patients & Methods: We retrospectively studied a cohort of adults with biopsy-proven MCD in terms of clinical features and treatment outcomes. Baseline characteristics and outcomes were recorded and predictors of relapse were analyzed using logistic regression multivariate analysis. Results: 59 patients with adult-onset primary MCD with nephrotic syndrome were included. Mean serum creatinine at diagnosis was 0.8 mg/dL (±2.5) and estimated GFR (eGFR) was 87 mL/min/1.73 m2 (±29.5). Mean serum albumin was 2.5 g/dL (±0.8) and 24 h proteinuria 6.8 g (±3.7). Microscopic hematuria was detected in 35 (58.5%) patients. 42 patients received prednisone alone, six patients received prednisone plus cyclophosphamide, five patients received prednisone plus cyclosporine, one patient received prednisone plus rituximab and five patients did not receive immunosuppression at all since they achieved spontaneous remission. During a mean follow up time of 34.7(22.1) months, 46.1% of patients experienced at least one episode of relapse. The mean age of patients who did not experience a relapse was significantly higher than that of patients who relapsed while relapsers had a significantly longer duration of 24 h proteinuria prior to biopsy compared to non-relapsers. Overall, 10% of patients experienced acute kidney injury while the mean eGFR at the end was 82 mL/min/1.73 m2 (±29.1) and one patient ended up in chronic dialysis. Overall, the proportion of non-relapsers, who experienced acute kidney injury (17%) was significantly higher than the one recorded among relapsers (0%).Conclusion: In this series of patients, almost 46% of adult-onset nephrotic MCD patients experienced a relapse, although their renal progression was rare. Younger onset age was an independent risk factor for relapse in adult-onset MCD patients.

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