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Abstract: PO1535

Infliximab-Associated Minimal Change Disease in an Adult with Ulcerative Colitis

Session Information

Category: Glomerular Diseases

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Thakkar, Kisan P., University of North Carolina System, Chapel Hill, North Carolina, United States
  • Manivannan, Surya, University of North Carolina System, Chapel Hill, North Carolina, United States
  • Malek, Irshadjahan, University of North Carolina System, Chapel Hill, North Carolina, United States
  • Jain, Koyal, University of North Carolina System, Chapel Hill, North Carolina, United States
Introduction

Tumor necrosis factor-alpha (TNF-α) inhibitors are increasingly utilized for the treatment of several autoimmune conditions. They have been associated, in rare cases, with renal complications. We report a patient who developed minimal change disease (MCD) and interstitial nephritis while being treated with infliximab (IFX) for ulcerative colitis (UC).

Case Description

A 48-year-old male with a history of primary sclerosing cholangitis, liver transplant 8 years prior, psoriasis, and UC well-controlled on monthly IFX presented with a one-week history of lower extremity swelling, dyspnea, and weight gain. He was found to have rapidly progressive renal failure and nephrotic syndrome. Laboratory data showed a serum creatinine of 11mg/dL up from 1mg/dL 3-weeks prior and urine protein:creatinine ratio (UPC) of 11g/g. Renal biopsy demonstrated acute interstitial nephritis (AIN) on light microscopy. Electron microscopy revealed global podocyte activation and foot process effacement, consistent with MCD (Figure). He continued to become progressively oliguric despite escalating doses of diuretics and received two days of hemodialysis due to volume overload. After a total of 7 days of high dose steroids, his urine output increased and hemodialysis was stopped. IFX was discontinued due to the association of TNF-α inhibitors with MCD and AIN. After a month of prednisone, his creatine improved to 1.6 mg/dL and UPC improved to 0.3g/g.

Discussion

This is the first report of IFX associated MCD. Although IFX has been associated with IgA nephropathy, crescentic glomerulonephritis, renal artery occlusion, membranous glomerulopathy, and AIN in patients with spondyloarthritis spectrum diseases, no reports exist in the literature regarding MCD. However, several case reports of Etanercept, another TNF-α inhibitor, associated with MCD exist. TNF- α inhibitors are implicated in immunoregulatory effects in the kidney, which are not well understood.

Diffuse global foot process effacement.