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Abstract: TH-PO970

A Horse in the Land of Zebras: A Case of Minimal Change Disease After Celecoxib Exposure

Session Information

Category: Trainee Case Report

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Shimonov, Daniil, NYP-Weill Cornell Medical Center, Forest Hills, New York, United States
  • Salvatore, Steven, Weill Cornell Medical College, New York, New York, United States
  • Shingarev, Roman A., Memorial Sloan Kettering Cancer Center, New York, New York, United States
Introduction

Non-selective NSAIDs are the most common cause of secondary minimal change disease (MCD). This association has not been established for selective COX-2 inhibitors, such as celecoxib. We present a case of celecoxib-associated MCD with unique diagnostic and therapeutic features.

Case Description

71 y/o F presented with abrupt nephrotic syndrome after a 2-week course of celecoxib. She has depression treated with sertraline and HTN controlled with diuretics. On presentation, her serum Cr was 0.8 mg/dl and her proteinuria (PU) measured 8 g. It did not improve with celecoxib discontinuation and lisinopril addition. Kidney biopsy revealed MCD without tubular or parenchymal pathology, however, foot process effacement was accompanied by lamellated “zebra” bodies in some podocytes (Figure) and minimal mesangial IgA deposits. Testing for genetic abnormalities and enzymatic activity of α-galactosidase ruled out Fabry disease. Her PU resolved after a 2-month prednisone course, but she relapsed soon after steroids discontinuation. Retreatment with a longer prednisone taper led to a prompt resolution of PU followed by another relapse accompanied by AKI. The second kidney biopsy showed MCD, new moderate interstitial fibrosis (IF) and tubular atrophy (TA), but no phospholipidosis. Her kidney function returned to baseline after 2 months, during which she was supported by dialysis, but PU persisted despite steroids. Subsequent addition of mycophenolic acid led to partial PU remission.

Discussion

Unlike prior sparse case reports documenting celecoxib-associated MCD, our patient did not initially have any IF or TA, nor did her PU remit spontaneously after celecoxib discontinuation. Although MCD responded well to prednisone, it eventually became steroid-resistant. While IgA deposits were deemed incidental and benign, sertraline-induced phospholipidosis could weaken the podocyte ability to maintain its structural integrity possibly exacerbating PU.

Zebra bodies