ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-PO469

A Case of Minimal Change Disease Associated With Salmonella Infection, Treated Successfully With Antibiotics

Session Information

Category: Glomerular Diseases

  • 1302 Glomerular Diseases: Immunology and Inflammation

Authors

  • Hasni, Syed, Rutgers New Jersey Medical School, Newark, New Jersey, United States
  • Michaud, Jennine, Veterans Health Administration Operations, East Orange, New Jersey, United States
  • Yudd, Michael, Veterans Health Administration Operations, East Orange, New Jersey, United States

Group or Team Name

  • Rutgers New Jersey Medical School
Introduction

This case is the first to our knowledge of Salmonella bacteremia associated with Minimal Change Disease in adults. The patient’s course lends further support to the hypothesis of a causal relationship between infections and MCD

Case Description

69-yom with pmh of HTN, treated HCV, who presented with a 3-week h/o diarrhea, abd. pain and LE edema. P/E showed ascites and LE edema. UA had >500 mg/dL protein, p/c ratio of 5, sediment with oval fat bodies and fatty casts, serum alb 2.2g/dL and cr of 1.1 mg/dL. Proteinuria workup negative for HIV, HBV, RPR, ANA, SPEP, UPEP, complements normal, HCV VL undetectable. Kidney biopsy showed MCD. Diarrhea resolved but proteinuria persisted, and patient was treated with oral prednisone 1mg/kg. 3 weeks later, patient developed UTI symptoms and received empiric ciprofloxacin. Urine culture grew Salmonella species group D. Blood cultures done following treatment were positive for Salmonella species group D. Clinical course complicated by relapsed Salmonella bacteremia, Salmonella vertebral osteomyelitis, ATN requiring temporary hemodialysis. With completion of steroid taper, prolonged IV antibiotic treatment and resolution of Salmonella infection, proteinuria resolved and never recurred.

Discussion

The infectious diseases leading to secondary MCD include Syphilis, Ehrlichiosis, Mycoplasma, HIV, TB, Echinococcus and Schistosomiasis. Our case demonstrates Salmonella can also cause a secondary MCD. In MCD, microbial products and/or interleukins bind to Toll-like receptors or IL receptors leading to CD80 expression, which in turn, may interfere with nephrin expression/phosphorylation. Angiopoietin-like-4 is thought to induce proteinuria by reducing anionic sites at the glomerular basement membrane level. Several candidate molecules have been considered as possible circulating factors. Often, with appropriate anti-microbial therapy of the underlying infectious disease, the MCD will abate.

Glomerular filtration barrier in healthy state (left) and in MCD (right)