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Review
. 2023 May 26;13(6):1264.
doi: 10.3390/life13061264.

Drug-Induced Podocytopathies: Report of Four Cases and Review of the Literature

Diamanto Athanasopoulou  1 , Sophia Lionaki  2 , Chrysanthi Skalioti  1 , George Liapis  3 , Panayiotis Vlachoyiannopoulos  4 , Ioannis Boletis  1
Affiliations
Review

Drug-Induced Podocytopathies: Report of Four Cases and Review of the Literature

Diamanto Athanasopoulou et al. Life (Basel). .

Abstract

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. In this article, we present four cases that presented with nephrotic syndrome and were diagnosed with biopsy-proven podocytopathies, associated with exposure to a certain medication. All of them experienced complete resolution of nephrotic syndrome within days or weeks after discontinuation of the offending drug. We also present the data, which were found in a Medline search from the year 1963 until the present, regarding cases with podocytopathies associated with penicillamine, tamoxifen and the combination of pembrolizumab-axitinib, including only adult cases from the English literature. The Medline search revealed 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 a Medline search from 1967 to the present of the English literature.

Keywords: axitinib; drug-induced glomerulonephritis; drug-induced podocytopathies; pembrolizumab; penicillamine; tamoxifen.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Light microscopy: glomeruli were unremarkable.
Figure 2
Figure 2
Electron microscopy: podocyte activation and foot processes effacement (blue arrows) with microvilli transformation, without substantial immune-complex deposits in glomerular basement membranes or mesangium.
Figure 3
Figure 3
Light microscopy: glomeruli showed no essential changes.
Figure 4
Figure 4
Electron microscopy: diffuse foot processes effacement (blue arrows) with microvilli transformation; no immune-complex deposits were found. Magnification: 2200×.
Figure 5
Figure 5
Light microscopy: acute tubular injury, in association with tubulointerstitial nephritis, as manifested by the aggregations of lymphocytes and monocytes into the interstitium (blue arrows), while glomeruli showed no abnormalities. Magnification: H&E 200×.
See this image and copyright information in PMC

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