Investigate the Impact of Drug-Induced Podocytopathies

Abstract

This chapter focuses on reviewing drug-induced podocytopathies by reporting four cases. Kidney injury due to medications is a well-known clinical entity. Although drug-induced tubulointerstitial disease is commonly encountered, there are few reports in the literature associated with glomerular injury due to medications. The recognition of this type of kidney injury is crucial, as rapid discontinuation of the offending agent is critical to maximizing the likelihood of quick and effective renal function recovery. For case 1, a 49-year-old female presented in 2017 with 1-week history of peripheral edema, increase in body weight up to 10 kg and intermittent unilateral lumbar pain has been selected. A 46-year-old female presented with nephrotic syndrome associated with new-onset significant peripheral edema and 1-day history of left-sided pleuritic chest pain has been chosen for the case 2. For the case 3, a 75-year-old female was referred to our clinic by her treating rheumatologist in 2012, with 15-day history of lower limb and bilateral eyelid edema and A 74-year-old man presented in 2020 with nephrotic syndrome and acute kidney injury has been selected as the case 4.

This study presents four cases that presented with nephrotic syndrome and were diagnosed with biopsy-proven podocytopathies, associated with exposure to a certain medication.  The chosen sample has experienced a complete resolution of nephrotic syndrome within days or weeks after discontinuation of the offending drug. This study also present the data, which were found in a Medline search from the year 1963 until  present, regarding cases with podocytopathies associated with penicillamine, tamoxifen and the combination of pembrolizumab-axitinib, including only adult cases from the English literature. This reviewrevealed nineteen cases of penicillamine- induced minimal-change disease (MCD), one case of tamoxifen-induced MCD, and none associated with pembrolizumab-axitinib therapy. We also searched for the largest studies and meta-analyses regarding drug-induced podocytopathies after an onlinesearch from 1967 to the present of the English literature Finally, the chapter is concluded that there is a variety of medications affecting the glomeruli and podocytes, manifested with various clinical pictures dependent on the affected part. Early recognition of these drug-induced glomerular diseases is mandatory and crucial, because rapid discontinuation of the offending agent is critical to maximize the likelihood of renal function recovery.