From diagnosis to treatment of minimal change disease in pregnancy

Preeclampsia accounts for the majority of nephrotic syndrome in pregnancy. However, primary renal diseases, although not as common, can also be the cause. The authors report a case of a 33-year-old pregnant woman at 22 weeks of gestation who presented with significant proteinuria, hypoalbuminemia, hyperlipidemia and discrete pitting edema. After the initial workup, a kidney biopsy was performed to diagnose minimal change disease (MCD), which revealed extensive podocyte foot process effacement. Treatment with IV methylprednisolone followed by oral prednisone led to remission, but a relapse occurred at 37 weeks of gestation. Labor was induced due to oligohydramnios with fetal growth restriction and a female hypotrophic neonate was delivered. Later on, the neonate developed sepsis and was successfully treated. Postpartum, the mother acquired a steroid resistance, and tacrolimus was used to achieve complete remission. In this case report, we emphasize the importance of kidney biopsy in adequately diagnosing primary renal diseases, even in pregnancy. This greatly helps clinicians in choosing the appropriate therapy for the patient, leading to disease remission.