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A case of acute appendicitis in a patient with minimal change disease
Fumiya Sato1, Shingo Nakayama2, Takuo Hirose1,3
1Division of Nephrology and Endocrinology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, 1-15-1 Fukumuro, Miyagino-Ku, Sendai, 983-8536, Japan.
Abstract:
Minimal change disease (MCD) is a common cause of idiopathic nephrotic syndrome (NS). MCD patients are complicated by acute kidney injury (AKI). Gastrointestinal disorders also occur during the course of NS; however, acute appendicitis after the development of NS has not been reported previously in patients with MCD. We report the case of a 54-year-old Japanese man with MCD who was diagnosed with acute appendicitis after developing NS. The patient visited a nearby medical clinic with abdominal distension, decreased urine volume, and edema of the face and lower limbs. As the symptoms did not improve and he developed abdominal pain, he was referred to the Division of Gastroenterology at our hospital. Hypoalbuminemia and proteinuria were detected, and he was introduced to our division and admitted for the evaluation and treatment of NS. After admission, right lower quadrant abdominal pain and rebound tenderness occurred, and an enlarged appendix and increased fat tissue density around the appendix were observed on abdominal and pelvic computed tomography. The patient underwent laparoscopic appendectomy for suspected acute perforated appendicitis and peritonitis. Although the patient required temporary hemodialysis due to oliguric AKI, the renal function and proteinuria improved with steroid therapy. We performed a renal biopsy, which revealed MCD with acute tubular injury. Since severe gastrointestinal disorders can occur in patients with MCD, these patients should be followed-up with carefully for acute abdominal pain. The prompt management of gastrointestinal disorders is important when acute abdominal pain occurs in patients with MCD.
Insights
Minimal change disease (MCD) can cause nephrotic syndrome (NS) and acute kidney injury (AKI). This report details a rare case of acute appendicitis in an MCD patient with NS, highlighting the need for careful gastrointestinal monitoring.
Area of Science:
- Nephrology
- Gastroenterology
- Internal Medicine
Background:
- Minimal change disease (MCD) is a primary cause of idiopathic nephrotic syndrome (NS), often associated with acute kidney injury (AKI).
- Gastrointestinal complications are known in NS patients, but acute appendicitis has not been previously reported in the context of MCD-related NS.
Purpose of the Study:
- To report a unique case of acute appendicitis occurring after the onset of nephrotic syndrome in a patient with Minimal Change Disease.
- To emphasize the potential for severe gastrointestinal complications in MCD patients and the importance of prompt diagnosis and management.
Main Methods:
- Case report of a 54-year-old Japanese male with MCD presenting with symptoms of NS and subsequent acute abdominal pain.
- Diagnostic workup included clinical evaluation, laboratory tests (hypoalbuminemia, proteinuria), abdominal and pelvic CT scan, and renal biopsy.
- Treatment involved laparoscopic appendectomy, steroid therapy, and temporary hemodialysis.
Main Results:
- The patient was diagnosed with nephrotic syndrome and subsequently developed acute appendicitis, requiring surgery.
- Renal biopsy confirmed Minimal Change Disease with acute tubular injury.
- Post-treatment, the patient's renal function and proteinuria improved with steroid therapy, despite requiring temporary hemodialysis for oliguric AKI.
Conclusions:
- Acute appendicitis is a potential, albeit rare, gastrointestinal complication in patients with Minimal Change Disease and nephrotic syndrome.
- Close monitoring for acute abdominal pain is crucial in MCD patients due to the risk of severe gastrointestinal disorders.
- Timely intervention for gastrointestinal issues is essential for managing these complex cases.
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