In Renal Rounds today Dr. Ali presented a case of 78 year old white female with ARF and Nephrotic syndrome with negative serologies and Biopsy showed Minimal change disease. She had history of intermittent NSAIDs use. Dr. S. Verma mentioned that in most of adult MCD with ARF, biopsies also show ATN, which is supported by the following paper.
Attached is retrospective study (cJASN) from columbia and NIH group. Other important points from this article:
1.MCD with ARF, patients tend to be older and hypertensive with lower serum albumin and more proteinuria than those without ARF.
2.At follow up, patients with an episode of ARF had higher serum creatinine than those without ARF. 3.These patients were less likely to have responded to steroids and more likely to have FSGS on repeat renal biopsy
Attached is retrospective study (cJASN) from columbia and NIH group. Other important points from this article:
1.MCD with ARF, patients tend to be older and hypertensive with lower serum albumin and more proteinuria than those without ARF.
2.At follow up, patients with an episode of ARF had higher serum creatinine than those without ARF. 3.These patients were less likely to have responded to steroids and more likely to have FSGS on repeat renal biopsy
Reminds me of "IgM Nephropathy:: a controversial topic. Found the following presentation by free googling:
ReplyDeletehttp://medicine.med.nyu.edu/nephrology/files/med_nephrology/attachments/IgM_Nephropathy.pdf
Yes, also MCD with IgA deposits... seen mainly in asian population.
ReplyDeleteNot much published since 1990s. Only isolated case reports in other populations. If IgA deposits are small..Response to steroids better compared to IgA nephropathy but probably not as good as plain MCD, more frequent relapses. If lot of deposits then behave more like IgA. (Based on case reports, no big literature...or atleast i didn't find).
We have a patient, newly diagnosed MCD with minimal Ig A deposits started prednisone, seems like he is responding very well (waiting for quantification, but trace on dipstick)