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Abstract: SA-PO860

Partial Remission of Minimal Change Disease on Steroids: A Real-Life Case Report

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

  • Marnet, Erica, Yale New Haven Health System, New Haven, Connecticut, United States
  • Sedaliu, Kaltrina, Yale New Haven Health System, New Haven, Connecticut, United States
Introduction

Minimal change disease (MCD) is a significant cause of primary nephrotic syndrome (NS). Less frequent in adults, around 10-15% of cases, and courses more frequently with hypertension, incomplete remission and steroid dependence. Management is generally extrapolated from pediatric data, highlighting the need to assess different therapies for the adult population.

Case Description

A 49-year-old male, with a history of hyperlipidemia, hypothyroidism presented with nausea, vomiting, oliguria, ascites and gravitational edema up to the abdomen. BP was 155/84 mmHg, serum creatinine (sCr) 2.97, serum albumin (sAlb) 1.8, UA with 4+ protein, 1+ glucose, urine protein/creatinine ratio (UPCR) 9.81. C3/C4, liver function, serologic evaluation and lymphoproliferative disorder work up were negative. Kidney biopsy demonstrated no sclerosis or immune complex deposition, but extensive effacement of foot processes suggestive of MCD. He was started on solumedrol then prednisone with good response. His edema was controlled with diuretics, those not needed on discharge. He did not tolerate steroids due to diabetes and myopathy. This rendered adherence to steroids difficult and his proteinuria worsened (Figure 1). Due to the financial burden of cyclophosphamide (CP) and dosing, he received 2 infusions of rituximab (RTX), followed by complete remission with no relapses, severe infection, or need of additional doses.

Discussion

MCD in adults differs from childhood in various factors as clinical course, relapses, secondary causes and treatment response. Limited data is available on adults. Frequent relapse or steroid dependence in MCD can occur up to 30% of patients. Despite RTX high remission rates in MCD refractory to other immunosuppressants, its role as a first agent after steroids is unknown. RTX is well tolerated in other causes of NS and requires fewer doses when compared to CP. This case shows RTX as a safe and cost-effective option for adult-onset MCD.