Abstract: PUB363
A Case of Spontaneous Remission of Idiopathic Minimal Change Disease in an Adult
Session Information
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Ramsawak, Seshma, Cleveland Clinic, Cleveland, Ohio, United States
- Linares, Andrea Rubi, Cleveland Clinic Florida, Weston, Florida, United States
- Dhingra, Jagmeet S., Cleveland Clinic, Cleveland, Ohio, United States
Introduction
Spontaneous early remission of primary minimal change disease (MCD) in adults is rare (5-10%). To mitigate risks of nephrotic syndrome such as thromboembolic events and infections, early initiation of treatment in adults is recommended. We present a case of complete spontaneous remission of MCD in an elderly adult with conservative management.
Case Description
A 73-year-old female with recently diagnosed hypertension, presented with dyspnea, lower extremity edema and an 8-pound weight gain. Evaluation revealed a serum creatinine of 1.5mg/dL (baseline 0.8 mg/dL) and hypoalbuminemia. Spot urine protein creatinine ratio (UPCR) was 7.28 mg/mg. Initial serological work up including ANA, ANCA, HIV, hepatitis, monoclonal screen and primary membranous testing were negative. No inciting factors including medications or recent illness were identified. A kidney biopsy was performed and showed findings of MCD. Due to the age at diagnosis, an evaluation to exclude underlying malignancy was performed. CT chest abdomen pelvis was unremarkable. Mammogram and gynecologic evaluation were normal and colonoscopy 9 months prior was also normal. The patient was managed with a combination of olmesartan, spironolactone and dapagliflozin, with plan to initiate steroid therapy if she remained nephrotic as patient expressed concerns over side effects associated with steroid use. She was monitored clinically and over the ensuing three months, UPCR improved with conservative therapy and she had complete remission 4 months post- biopsy. Her most recent UPCR was 0.1 mg/mg and creatinine stable at 1.2 mg/dl.
Discussion
The majority of MCD cases achieving spontaneous remission are due to secondary causes. The mainstay of therapy for patients diagnosed with MCD, in addition to supportive measures, is immunosuppressive therapy. The goal is to induce remission thereby minimizing adverse outcomes associated with nephrotic syndrome. Glucocorticoid monotherapy is first line but alternative glucocorticoid sparing options are also available. Treatment with these agents have inherent risk. This case highlights a rare occurrence of spontaneous complete remission of idiopathic MCD in an adult patient. Physicians should be cognizant of the risk versus benefit ratio of immunosuppressive agents, especially in an elderly population.