Abstract: PUB328
A Rare Case of "No Change Disease" Presenting as an Unexplained Nephrotic Syndrome
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Choi, Jusong, Georgia Nephrology, Lawrenceville, Georgia, United States
- Badra, Sherif, Florida Kidney Physicians, Riverview, Florida, United States
- Kim, Jeongheun, Georgia Nephrology, Lawrenceville, Georgia, United States
Introduction
"Nephrotic syndrome" delineates a unique set of clinical and laboratory manifestations of kidney disease. It is precisely characterized by pronounced proteinuria (> 3.5 g/24 hours), hypoalbuminemia (< 3.5 g/dL), and peripheral edema. Here, we present a case illustrating nephrotic syndrome in the absence of distinct histologic evidence substantiating the pathological process.
Case Description
60 year-old female with history of hypertension and a previous tuberculosis infection treated. Referred by PCP due to albuminuria on urinalysis after contracting COVID-19 in September 2023. Her sole symptom post-COVID-19 was foamy urine, prompting to obtain an ACR which showed 1.8 g/g, and a subsequent test in following month revealed 2.6 g/g. She maintains a preserved eGFR with a baseline creatinine level of 0.6 mg/dL. No prior history of albuminuria from the previous lab.
The initial workup results were as follows:
Creatinine: 0.59 mg/dl
Albumin: 3.6 g/dl
UA: Positive for occult blood and 3+ protein, but negative for red and white cells
C3 and C4 within normal limits
Negative results for Anti-GBM, ANA, PR3, MPO, parvovirus B19, RPR, hepatitis, HIV, PLA2R antibodies
Without further delay, a biopsy was performed, and the results showed it to be unremarkable except for arteriosclerosis. Post-biopsy, a 24-hour urine protein of 5.2g was collected, and both UPEP and SPEP with IFE, urine cytology were unremarkable. Subsequently, her proteinuria worsened up to 7.7 g/g along with worsening hypoalbuminemia to 2.2 g/dL, resulting in nephrotic syndrome. The decision was made to start Prednisone 50 mg daily.
With the initiation of prednisone, both proteinuria and hypoalbuminemia improved within 4 weeks and continue to be in remission with 24-hour urine protein at 120 mg at week 7 of treatment.
Discussion
Likely diagnosis for this case is post-COVID Minimal Change Nephrotic Syndrome. This case underscores the importance for clinicians to recognize that podocyte foot process effacement does not always correlate with proteinuria. Variances in podocyte effacement observed between MCNS and other types of nephrotic range proteinuria disorders may suggest diverse mechanisms of podocyte injury in these conditions. Extensive foot process effacement is typically associated with the presence of a full nephrotic syndrome, characterized by concurrent nephrotic range proteinuria and hypoalbuminemia.