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[MCNS, which secondary developed into incidental IgA nephropathy--a case report]
N Tsunehisa1, T Takemura, T Inui
1Department of pediatrics Mie National Hospital, Japan.
Abstract:
There have been a number of case reports on nephrotic syndrome with histological findings of minimal change on light microscopy and mesangial IgA deposition on fluorescent microscopy. The pathogenesis of these cases is, however, yet to be clarified. Here, we report a case of minimal change nephrotic syndrome (MCNS) associated with IgA nephropathy, which developed later in the course of MCNS. The patient was 18 years old male with steroid-responsive nephrotic syndrome. First episode of proteinuria occurred when he was 4 years old. On the fourth episode of proteinuria, renal biopsy revealed minimal change on light microscopy and no evidence of deposition of immunoglobulins or complements on immunofluorescent and electron microscopy. On the fifth relapse of MCNS, microhematuria developed concomitantly with massive proteinuria. Renal biopsy, then, showed light microscopic findings of mild focal segmental glomurulonephritis. Significant mesangial IgA deposition was observed on immunofluorescence study. Electron microscopy revealed electron dense deposit in the mesangial and paramesangial area. The patient was well-responsive to steroid although microhematuria persisted after disappearance of proteinuria. We concluded that IgA nephropathy may have developed subsequently in the course of MCNS in our case.
Insights
Minimal change nephrotic syndrome (MCNS) can evolve into IgA nephropathy. This case report details a patient who developed IgA nephropathy during the course of MCNS, highlighting potential disease progression.
Area of Science:
- Nephrology
- Immunopathology
Background:
- Minimal change nephrotic syndrome (MCNS) is a common cause of nephrotic syndrome in children and adults.
- The pathogenesis of MCNS is not fully understood, but it is often associated with T-cell dysfunction.
- IgA nephropathy is characterized by deposition of IgA in the glomeruli and can lead to chronic kidney disease.
Observation:
- A case of an 18-year-old male with a history of steroid-responsive nephrotic syndrome is presented.
- Initial renal biopsies showed minimal change disease without immunoglobulin deposition.
- On fifth relapse, proteinuria and microhematuria developed, with subsequent biopsies revealing focal segmental glomerulonephritis and mesangial IgA deposition.
Findings:
- The patient presented with steroid-responsive nephrotic syndrome.
- Sequential renal biopsies demonstrated a progression from minimal change disease to IgA nephropathy.
- Despite steroid treatment, microhematuria persisted after proteinuria resolved.
Implications:
- This case suggests that IgA nephropathy can develop subsequent to minimal change nephrotic syndrome.
- Understanding this potential progression is crucial for accurate diagnosis and management of nephrotic syndromes.
- Further research is needed to elucidate the mechanisms underlying the transition from MCNS to IgA nephropathy.