Abstract: SA-PO855
Minimal Change Disease Secondary to Adalimumab
Session Information
- Glomerular Diseases: Case Reports - 2
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Allen, James, Rutgers University Newark, Newark, New Jersey, United States
- Kaplan, Joshua, Rutgers University Newark, Newark, New Jersey, United States
- Mahendrakar, Smita, Rutgers University Newark, Newark, New Jersey, United States
Introduction
Adalimumab is a fully human recombinant monoclonal antibody against TNFa. There have been case reports of patients developing proteinuria following treatment with adalimumab for rheumatoid arthritis (RA). Renal pathology demonstrating membranous glomerulopathy, pauci-immune necrotizing and crescentic glomerulonephritis have been reported. We describe a patient who developed minimal change disease as an adverse effect of treatment with the anti-TNFa adalimumab.
Case Description
A 63-year-old female with seropositive RA treated with adalimumab presented to the hospital with generalized swelling. Symptoms started seven days prior to admission after she received her fifth injection of adalimumab. Generalized swelling was noted the morning after her dose. She met clinical criteria for nephrotic syndrome with nephrotic range proteinuria, hypoalbuminemia, peripheral swelling, and hyperlipidemia. Significant labs included cholesterol and triglycerides of 413mg/dL and 392mg/dL, up from 208mg/dL and 178mg/dL prior to adalimumab injection. Albumin was up from 4.1gm/dL four months prior to 1.6gm/dL on admission. 24-hour urine protein was greater than 3.9g/day. Renal biopsy was obtained which showed minimal glomerular alterations with marked effacement of foot processes ultra-structurally and negative immunofluorescence studies consistent with minimal change disease. Treatment was initiated with 1mg/kg/day of prednisone with following taper after one month. Supportive management including statins and diuretics was prescribed. With the protein to creatinine ratio decreasing to 0.106g/day and albumin improving to 4.2gm/dL on the two month follow up, steroids were discontinued.
Discussion
We present a case of a rare cause of adult-onset minimal changed disease secondary to adalimumab. Patients on anti-TNF therapy should be monitored for signs of nephrotic syndrome including peripheral edema, proteinuria, and hypoalbuminemia.