Nephrotic Syndrome Induced by Tiopronin in a Male Patient with Cystinuria

Karanfilovski, V; Severova Stojanoska, A; Ristovska, V; Gjorgjievska, J; Tasic, V; Arsov, T; Dzekova-Vidimliski, P; Plaseska-Karanfilska, D; Nikolov, I; Gjorgjievski, N

Nephrotic Syndrome Induced by Tiopronin in a Male Patient with Cystinuria

Volume 28 (2025): Issue 1 (June 2025)

By:

V Karanfilovski, A Severova Stojanoska, V Ristovska, J Gjorgjievska, V Tasic, T Arsov, P Dzekova-Vidimliski, D Plaseska-Karanfilska, I Nikolov and N Gjorgjievski

Open Access

|Oct 2025

Figures & Tables

Laboratory parameters during the treatment and follow-up of the patient

Laboratory parameter	On admission	7^th day of hospitalization	After one month
24 hours proteinuria (normal < 0.1 g/l)	6.6 g/l	0.18 g/l	0.2 g/day
Serum albumin (normal 35–50 g/l )	19 g/l	31 g/l	49 g/l
Total proteins (normal 63–83 g/l)	41 g/l	56 g/l	73 g/l
Total cholesterol (normal < 5.17 mmol/l)	6.6 mmol/l	4.8 mmol/l	3.76 mmol/l
Serum creatinine (normal 45–109 μmol/l)	75 μmol/l	71 μmol/l	73 μmol/l

Reported cases of Tiopronin-induced nephrotic syndrome in patients with cystinuria

Authors	Age (years)	sex	Dosage	Occurrence time after initiation of tiopronin	Clinical presentation	Renal biopsy findings	Therapy	Outcome
Our case	18	male	10 mg/kg/day	3 months	nephrotic syndrome with proteinuria of 6.6 g/l	No	tiopronin withdrawal	complete remission after 7 days
Tasic V et al (2011)¹⁶	3	male	10 mg/kg/day	9 months	nephrotic syndrome	No	tiopronin withdrawal	complete remission after 10 days
Vidoviæ L et al (2021)⁵	22	female	no data	4 months	nephrotic syndrome with proteinuria of 4.4 g/day	acute interstitial nephritis	tiopronin withdrawal and prednisone 60 mg	remission with proteinuria 0.4 g/24 h after 7 days
Iwanaka Y et al (2024)¹⁸	13	female	9.1 mg/kg/day	44 months	nephrotic syndrome	No	tiopronin withdrawal	complete remission after 10 days
Kalbani Al et al (2020)¹⁹	13	male	12 mg/kg/day	3 months	nephrotic syndrome	No	tiopronin withdrawal	complete remission after 1 month
Micallef S et al (2022)²⁰	16	male	12 mg/kg/day	16 months	acute kidney injury and nephrotic syndrome with proteinuria 6 g/day	membranous nephropathy, likely drug-induced.	tiopronin withdrawal	serum creatinine dropped to 117 μmol/l and albumin:creatinine ratio to 47.7 mg/g (normal range 1–20 mg/g) within 2 months
Lecoules S et al (1999)²¹	73	male	no data	6 weeks	severe nephrotic syndrome	minimal glomerular lesions	tiopronin withdrawal	complete remission 5 weeks after withdrawal
Shibasaki T et al (1990)²²	26	male	no data	36 months	nephrotic syndrome	membranous glomerulonephritis (MN) at stage I	tiopronin withdrawal and prednisone	complete remission
Yamashita J et al (2024)¹⁴	41	female	600–1600 mg/day	6 months	nephrotic syndrome with proteinuria of 5.5 g/gCre (normal < 0.2 g/gCre)	membranous nephropathy with strong deposition of immunoglobulin G4	tiopronin withdrawal	remission after 1 year. After 5 years tiopronin was reintroduced, nephritic syndrome appeared again, and tiopronin was stopped with remission after 6 months
Santoriello D et al (2023)¹⁵	53	male	no data	7 months	nephrotic syndrome with proteinuria of 4.6 g/day and slightly elevated serum creatinine	Segmental membranous nephropathy, NELL-1 positive	tiopronin withdrawal, telmisartan and dapagliflozin	After 6 months normal serum creatinine and albumin, but a protein-to-creatinine ratio of 2.08 g/g (patient with diabetes, obesity)

DOI: https://doi.org/10.2478/bjmg-2025-0012 | Journal eISSN: 2199-5761

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Language: English

Published on: Oct 8, 2025

Published by: Macedonian Academy of Sciences and Arts

In partnership with: Paradigm Publishing Services

Publication frequency: 2 times per year

Keywords:

Cystinuria,

tiopronin,

adverse drug reaction,

nephrotic syndrome

Related subjects:

Medicine,

Basic medical science,

Basic medical science, other

© 2025 V Karanfilovski, A Severova Stojanoska, V Ristovska, J Gjorgjievska, V Tasic, T Arsov, P Dzekova-Vidimliski, D Plaseska-Karanfilska, I Nikolov, N Gjorgjievski, published by Macedonian Academy of Sciences and Arts
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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