An unexpected presentation: minimal change disease in an adult with treatment-naïve hepatitis C

Area of Science:

• Nephrology
• Internal Medicine
• Pathology

Background:

• Minimal change disease is the most frequent cause of nephrotic syndrome in children but is less common in adults.
• Adult glomerular diseases often have distinct associations, like hepatitis C with membranoproliferative glomerulonephritis.
• Differential diagnoses in adults include focal segmental glomerulosclerosis, particularly in African-American males with risk factors like reflux nephropathy.

Observation:

• A middle-aged African-American male presented with nephrotic syndrome and acute renal failure.
• He was diagnosed with a new hepatitis C infection concurrently.
• His medical history included urethral strictures, suggesting potential reflux nephropathy.

Findings:

• Extensive laboratory workup did not definitively identify the cause of massive proteinuria.
• A renal biopsy confirmed the diagnosis of minimal change disease.
• Treatment with high-dose steroids led to remission of proteinuria and resolution of acute renal failure.

Implications:

• This case underscores that minimal change disease can occur in adults, even with risk factors for other glomerular diseases.
• Hepatitis C infection may be a trigger or co-morbidity in adult minimal change disease.
• Prompt diagnosis and treatment with corticosteroids can lead to favorable outcomes in adult minimal change disease, avoiding dialysis.