A case report of spontaneous remission and relapse in minimal change disease: a heterogeneous disease entity

Minimal change disease (MCD) is a common cause of nephrotic syndrome and typically responds well to glucocorticoid therapy. Although spontaneous remission is considered rare, its true frequency may be underestimated, possibly due to the early initiation of treatment in most cases. We report a case of a 45-year-old male who developed nephrotic syndrome following an influenza infection. A kidney biopsy revealed findings consistent with minimal change disease, including diffuse foot process effacement, and proteinuria resolved spontaneously without immunosuppressive therapy. The patient remained in remission for approximately four and a half months until he developed a non-influenza upper respiratory infection, which was followed by a relapse of nephrotic syndrome. Subsequently, glucocorticoid therapy was initiated, resulting in a prompt remission. This case highlights the potential for spontaneous remission in MCD, particularly in the context of infection, and underscores the immunological heterogeneity of the disease. We also review previously reported adult cases of infection-associated spontaneous remission of MCD.