Abstract: PUB329
A Patient with Minimal Change Disease with AKI
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Varughese, Ashok Abraham, Lower Bucks Hospital, Bristol, Pennsylvania, United States
- Geara, Abdallah Sassine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Yu, Tammy, University of Pennsylvania, Philadelphia, Pennsylvania, United States
Introduction
Minimal change disease (MCD) accounts for about 10% of nephrotic syndrome in adults. While MCD typically presents with a rapid onset of nephrotic syndrome, it can also be associated with acute kidney injury in about 18% of cases. Most cases of MCD are considered idiopathic; it has been associated with a variety of secondary causes though no clear association with an underlying disease or event has been established.
Case Description
A 68-year-old male presents to the emergency department for progressive leg swelling, abdominal distension, dark urine, and shortness of breath for two weeks. Medical history was notable for hypertension treated with lisinopril, hyperlipidemia, type II diabetes mellitus, osteoarthritis managed with Ibuprofen daily for the past 1 year. Laboratory tests revealed serum creatinine of 5.32 mg/dL, blood urea nitrogen of 52 mg/dL. The patient become anuric within 24 hours of admission and required one session of hemodialysis. The differential diagnosis was broad and was favoring acute tubular necrosis possibly due to NSAIDs use. Since the etiology was not clear, without a clear hypovolemic or hypoperfusion event, the patient underwent a kidney biopsy which demonstrated on light microscopy focal acute tubular necrosis acute , the immunofluorescence stainings were found to be negative, electron microscopy revealed global podocyte foot process effacement, consistent with minimal change disease associated with acute tubular necrosis.
Discussion
Identifying the etiology of MCD can be challenging. In this case, multiple causes were plausible, but the exact cause remains unclear. Rapid progression into nephrotic syndrome and anuric AKI are uncommon in MCD. The patient had a history of using Ibuprofen daily for arthritis, which has been associated with MCD in rare cases, though there was no concurrent interstitial nephritis seen on kidney biopsy a common accompanying finding in NSAIDs-induced MCD .