Alogliptin-Induced Minimal Change Nephrotic Syndrome and Interstitial Nephritis

• Main Authors: Hisato Shima, Takuya Okamoto, Manabu Tashiro, Tomoko Inoue, Chiaki Masaki, Hiroaki Tada, Norimichi Takamatsu, Kazuhiko Kawahara, Kazuyoshi Okada, Toshio Doi, Jun Minakuchi, Shu Kawashima
• Format: Article
• Language: English
• Published: Elsevier 2019-03-01
• Series: Kidney Medicine
• Online Access: http://www.sciencedirect.com/science/article/pii/S2590059519300202

Alogliptin is one of the dipeptidyl peptidase-4 inhibitors used to treat patients with type 2 diabetes. Little is known about the nephrotoxicity associated with alogliptin, such as nephrotic syndrome or interstitial nephritis. We report a biopsy-proven rare case of minimal change nephrotic syndrome and interstitial nephritis induced by alogliptin. A 68-year-old man who had been prescribed alogliptin was hospitalized for nephrotic syndrome. On admission, serum creatinine level was elevated with increased urinary β2-microglobulin and N-acetyl-β-d-glucosaminidase excretion. Kidney biopsy revealed minor glomerular abnormalities and interstitial nephritis, and gallium-67 scintigraphy showed uptake in both kidneys. A drug lymphocyte stimulation test for alogliptin was positive. With discontinuation of alogliptin treatment alone, serum creatinine level normalized in parallel with urine β2-microglobulin and N-acetyl-β-d-glucosaminidase levels. In addition, complete remission of nephrotic syndrome was observed. Drug-induced dual pathology has not been previously reported with alogliptin. In summary, clinicians should keep in mind that alogliptin can induce minimal change nephrotic syndrome and interstitial nephritis. Index Words: Alogliptin, minimal change nephrotic syndrome, interstitial nephritis, gallium-67 scintigraphy, drug lymphocyte stimulation test