#5680 first report of an evolocumab induced nephrotic syndrome

Abstract Background and Aims Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9 inhibitors) reduce LDL-C and short-term risk of cardiovascular events by acting on the proprotein convertase subtilisin/kexin type 9 (PCSK9), an enzyme produced in the liver. This article highlights the case of a 69 year-old man who developed nephrotic syndrome (NS) secondary to EVOLOCUMAB injection. To our knowledge, this is the first time that minimal change disease is described as associated with EVOLOCUMAB. Method Case Report describing a 69-year-old male with coronary artery disease who started EVOLOCUMAB injection every two weeks. Six weeks later, after the third dose of Evolocumab, he developed edema, and high blood pressure 180/90 mmHg. Laboratory tests showed a creatinine of 88 µmol/l and a GFR of 77 ml/min/m² associated with severe proteinuria of 9g/24H, normal level of anti-PLA2R, negative ANA (<1/80) and ANCA (<1/80), and negative hepatitis B and C serology. Results Kidney biopsy was obtained to investigate this nephrotic syndrome and showed minimal change disease. There was a mild focal mesangial prominence not exceeding three or four cells per segment by light microscopy (LM). Immunofluorescence was negative. EVOLOCUMAB was stopped and proteinuria dropped from 9g to 6g/25H, and stabilized at that level, so treatment with prednisone 1mg/kg was initiated, reducing proteinuria to 3g/24H one month later with clinical improvement. Conclusion The occurrence of reversible glomerular lesions reported here should be considered as a potential adverse effect when administrating a prolonged treatment of Evolocumab. We suggest performing urine test at least once a week, to detect early proteinuria in patients receiving this medication.