Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guidelines
Image in Nephrology
Images in Nephrology
Letter to Editor
Letter to the Editor
Letters to Editor
Literature Review
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guidelines
Image in Nephrology
Images in Nephrology
Letter to Editor
Letter to the Editor
Letters to Editor
Literature Review
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
View/Download PDF

Translate this page into:

Letters to Editor
25 (
2
); 127-128
doi:
10.4103/0971-4065.145130

Membranous nephropathy associated with the use of levodopa-carbidopa combination

Department of Nephrology, Sri Venkateshwara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
Department of Neurology, Sri Venkateshwara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
Address for correspondence: Dr. Ram Rapur, Department of Nephrology, Sri Venkateshwara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India. E-mail: ram_5_1999@yahoo.com
Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.

Sir,

Membranous nephropathy (MN) is the cause of nephrotic syndrome in approximately 25% of adults.[1] In over 75% of patients of MN, no aetiological agent can be determined. Drugs account for 6–9% of secondary MN.[2] Drug associated MN can develop at any age and typically develops soon after exposure to the offending agent.[3] The classic offenders are gold, penicillamine, nonsteroidal anti-inflammatory drugs and captopril, though there are reports for many other drugs. We could not find, after a thorough literary search a single report of levodopa-carbidopa combination associated with MN.

We present a 45-year-old male patient who has been on regular follow up for Parkinson's disease (PD) for the past 6 months. He was being treated with levodopa-carbidopa combination, 110 mg twice a day. He presented with history of gradually worsening swelling of feet and face of 2 months duration. There was a history of oliguria and increased frothiness of urine. His blood pressure at presentation was 120/80 mmHg. Investigations were given in the Table 1.

Table 1 Investigations

Renal biopsy showed 11 glomeruli. All glomeruli were normal in size. The capillary loops were stiff, round and patent with thick basement membrane. Silver methanamine stain showed spikes. Tubules and vascular system were unremarkable. Immunofluorescence showed diffuse granular deposits with immunoglobulin G (IgG) 3+, IgA trace, IgM trace and C3 2+ along the capillary loops. The features were suggestive of MN. Serum anti-phospholipase-A (2)-receptor (PLA2R) antibodies, done by enzyme-linked immunosorbent assay, were negative. Suspecting that the levodopa-carbidopa combination would be a cause of MN, it was stopped. Ropinirole 0.5 mg, half tablet bid was started. During next 4 weeks, the swelling of feet and face have disappeared, the proteinuria declined to 414 mg/day, serum total proteins and serum albumin improved to 6.7 g/dl and 3.9 g/dl respectively.

Serum anti phospholipase-A2-receptor antibodies are present in 70% of patients with idiopathic MN with active disease.[4] The anti-PLA2R antibodies were found to be present in reports of patients with secondary MN. These patients were one out of 20 patients of systemic lupus erythematosus, one out of 16 patients of hepatitis B associated MN, three out of 10 patients of malignancy associated MN and one report of sarcoidosis associated MN. The accuracy of anti-PLA2R antibodies to identify idiopathic MN and to exclude secondary causes of MN awaits well-designed prospective studies, which are currently underway.[5]

In our patient, the temporal relation of use of the levodopa-carbidopa with the onset of symptoms, the reduction of the proteinuria consequent to its stoppage and absence of anti PLA2R antibodies all pointed to a possible association of levodopa-carbidopa combination with the MN. Spontaneous remission of the MN could also be another possibility.

References

  1. , , , , , , . Changing incidence of glomerular diseases in adults. Am J Kidney Dis. 2000;35:878-83.
    [Google Scholar]
  2. , , , , , . Aetiology of membranous glomerulonephritis: A prospective study of 82 adult patients. Nephrol Dial Transplant. 1989;4:172-80.
    [Google Scholar]
  3. , , . Gold nephropathy prototype of membranous glomerulonephritis. Am J Pathol. 1974;75:573-90.
    [Google Scholar]
  4. , , , , , , . M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med. 2009;361:11-21.
    [Google Scholar]
  5. , , . Anti-PLA2R antibodies in membranous nephropathy: Ready for routine clinical practice? Neth J Med. 2012;70:109-13.
    [Google Scholar]

    Fulltext Views
    46

    PDF downloads
    28
    View/Download PDF
    Download Citations
    BibTeX
    RIS
    Show Sections