Diffuse and broad podocytic detachment in a case of nephrotic syndrome associated with Kimura's disease

We report a 49-year-old Japanese male with nephrotic syndrome associated with Kimura's disease. Renal biopsy revealed diffuse podocytic detachment from the glomerular basement membrane (GBM). He had an episode of nephrotic syndrome when complete remission was induced with steroid therapy six years prior to the present admission. However, complete remission of the nephrotic syndrome was not achieved by the steroid on this admission and massive proteinuria (5 g/day) persisted. We suggest that steroid-resistant proteinuria is closely related to podocytic detachment from the GBM and that the production of extracellular matrix by epithelial cells may participate in segmental sclerotic lesions in the patient.