Abstract: TH-PO469
A Case of Minimal Change Disease Associated With Salmonella Infection, Treated Successfully With Antibiotics
Session Information
- Glomerular Diseases: Podocytopathies and Nephrotic Syndromes
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
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)