Abstract: TH-PO977
Doxycycline-Associated Minimal Change Disease
Session Information
- Glomerular Trainee Case Reports
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1204 Podocyte Biology
Authors
- Parikh, Rushang, Zucker School of Medicine at Hofstra/Northwell, NY, Manhasset, New York, United States
- Uppal, Nupur N., Hofstra Northwell School of Medicine, Great Neck, New York, United States
- Bijol, Vanesa, Northwell Health Hofstra University, Lake Success, New York, United States
Introduction
Minimal Change Disease (MCD) is a disease that usually affects adolescents, however 10-25% of nephrotic syndrome in adults is also caused by MCD. Major causes that precipitate MCD in adults include infection, neoplasm, allergy, and drugs. We describe a rare case of MCD associated with doxycycline use.
Case Description
A 24-year-old Caucasian female with history of IBD presented to emergency department (ED) with worsening swelling of lower extremities. 4 weeks prior she was diagnosed with Influenza A, treated with Oseltamivir, and the week before presentation had mild fever when was diagnosed with acute sinusitis and initiated on doxycycline therapy. After taking doxycycline for 4 days, she started having "dizzy spells" followed by appearance of severe swelling over lower extremities with palpebral and perioral edema. Her systolic BP was 150s which was unusual for her. UA performed at Urgent Care center revealed RBCs in the urine and protein of 300 mg. She was transferred to ED, where was noted to have persistently elevated BP, with repeat UA also showing RBCs and protein. Spot urine protein/Creatinine was elevated at 10.3, with a serum creatinine of 0.62 mg/dL and albumin of 2.1 g/dL. Patient underwent kidney biopsy which showed “extensive effacement of visceral epithelial cell foot processes, suggestive of minimal change disease, and thin glomerular basement membranes, suggesting an inherited abnormality of basement membrane collagens.” She was started on high-dose prednisone, to which she responded well. Her lower extremity swelling and proteinuria completely resolved within 2 weeks of corticosteroid therapy, and prednisone was subsequently tapered.
Discussion
Doxycycline is a widely available antibiotic that is readily used in the treatment of multiple pathogens. It is not typically associated with MCD however it has been shown to cause MCD in mice due to causing overexpression of VEGF-A in the kidneys which results in albuminuria and minimal change disease. To our knowledge, there has been only one reported case of doxycycline related MCD in humans. Physicians including internists, infectious disease specialists and nephrologists need to be aware of this potential adverse effect of doxycycline.