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Abstract: TH-PO146

Infliximab-Associated Focal Segmental Glomerulosclerosis in a Patient with Crohn Disease: A Case Report

Session Information

Category: Trainee Case Report

  • 1201 Glomerular Diseases: Fibrosis and Extracellular Matrix

Authors

  • Gokhale, Avantee V., Icahn SOM at Mount Sinai, NY, New York, United States
  • Deshpande, Priya, Icahn SOM at Mount Sinai, NY, New York, United States
Introduction

Infliximab is a monclonal antibody against tumour necrosis factor alpha (TNFα) used for immune mediated disorders such as ulcerative Colitis, Crohn’s Disease, ankylosing spondylitis. Renal effects of Infliximab are uncommon and are poorly understood. Effects mentioned in literature review include acute tubulo-interstitial nephritis, focal segmental glomerulosclerosis (FSGS) and membranous nephropathy. Herein we present a case of biopsy proven FSGS in the setting of Infliximab use in a patient with Crohn’s disease.

Case Description

We present a case of a 36 years old male Caucasian patient with Crohn’s disease on treatment with Infliximab for 20 months, who presented with a symptom of urinary frequency. His urinalysis demonstrated microhematuria and urine protein excretion was 2.1g with serum albumin level of 3.2 g/dL. He underwent a renal biopsy that showed FSGS tip lesion with acute tubular necrosis. His Infliximab dose was titrated off. Subsequently, he was started on an angiotensin receptor blocker losartan at 25 mg and the dose was increased as tolerated. His proteinuria and hematuria improved with this therapy and after 2 months a repeat urinalysis showed 0.3g of proteinuria and absence of microhematuria. This is only the third known case of biopsy proven FSGS reported with Infliximab use.

Discussion

Our case highlights an uncommon adverse effect of a commonly used medication. Contrary to the other two cases, which reported renal effects within first 6 months of infliximab therapy, we found renal involvement even after 20 months of infliximab suggesting possibility of delayed effects on kidneys. The possible mechanism responsible for the development of renal complications during anti-TNFα infliximab administration implicates an interaction of anti-TNFα antibodies with TNFα present on glomerular visceral epithelial cells. These effects of the TNFα inhibitors should trigger screening urinalysis in patients on these medications for early diagnosis and management of renal effects. Future research should elucidate the links behind the renal effects of infliximab.