Case
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Diagnosis: Minimal Change Disease and Acute Tubulointerstitial Nephritis
The association between nonsteroidal anti-inflammatory drugs (NSAIDs) and nephrotic syndrome has long been recognized. Minimal change disease and membranous nephropathy have been the most common findings in those patients in whom a kidney biopsy was performed. Regarding NSAIDs-related minimal change disease, it is a peculiar type of nephrotic syndrome in which most of reported patients present with a severe AKI accompanying nephrotic syndrome manifestations. Kidney biopsies typically show the characteristic pattern of drug-induced acute interstitial nephritis (AIN): a diffuse interstitial infiltrate composed predominantly of T lymphocytes, although eosinophils, macrophages, and plasma cells can also be observed. The glomeruli are normal in light microscopy, but a diffuse effacement of podocyte foot processes is observed in electron microscopy (Mérida E, Praga M. NSAIDs and Nephrotic Syndrome. Clin J Am Soc Nephrol. 2019;14(9):1280-1282. [PubMed link]).
In this case, it was considered that the renal alterations had no direct relationship with vaccination.
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References
- Drożdżal S, Lechowicz K, Szostak B, Rosik J, Kotfis K, Machoy-Mokrzyńska A, Białecka M, Ciechanowski K, Gawrońska-Szklarz B. Kidney damage from nonsteroidal anti-inflammatory drugs-Myth or truth? Review of selected literature. Pharmacol Res Perspect. 2021;9(4):e00817.[PubMed link]
- Bakhriansyah M, Souverein PC, van den Hoogen MWF, de Boer A, Klungel OH. Risk of Nephrotic Syndrome for Non-Steroidal Anti-Inflammatory Drug Users. Clin J Am Soc Nephrol. 2019;14(9):1355-1362. [PubMed link]
- Mérida E, Praga M. NSAIDs and Nephrotic Syndrome. Clin J Am Soc Nephrol. 2019;14(9):1280-1282. [PubMed link]