Abstract: FR-PO949
Spontaneous Remission of Minimal Change Disease during Pregnancy
Session Information
- Glomerular Diseases: Potpourri
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Yip, Henry, Stony Brook University Hospital, Stony Brook, New York, United States
- Kim, Claire, Stony Brook University Hospital, Stony Brook, New York, United States
- Tahir, Hira, Stony Brook University Hospital, Stony Brook, New York, United States
- Kaur, Navdeep, Stony Brook University Hospital, Stony Brook, New York, United States
Introduction
Minimal change disease (MCD) is a pediatric predominant glomerulonephropathy which can cause nephrotic syndrome (NS). Current societal guidelines for the management MCD in adults is based on observational data from the pediatric population, creating limitations in management. In this case we present a case of new onset MCD in a pregnant adult.
Case Description
A 34 year old female with no past medical history who is one month pregnant presents for evaluation of new onset edema. Initial testing found urine protein:creatinine ratio (UPCr) 4.5, urine microalbumin creatinine ratio (UMACR) 2.9, serum albumin of 2.9g/dL. Serum creatinine was 0.49 mg/dl. Further serologic and infectious workup was negative; genetic testing was performed and was inconclusive. A 24-hour urine collection showed 6 grams of protein. A biopsy was performed, with no findings on light microscopy and podocyte effacement on electron microscopy. Maternal fetal medicine (MFM) started her on aspirin and enoxaparin for venous thrombosis (VTE) prophylaxis. Repeat UPCr had decreased to < 3 by her 18th gestational week and a joint decision was made to defer treatment with monitoring given improvement in proteinuria. Patient delivered on time without any complications. UPCr continued to trend down and at her one month postpartum visit, urinalysis showed no protein in urine.
Discussion
Nephrotic syndrome occurs in 0.012% of all pregnancies, and specifically minimal change disease predominantly occurs in children making the presence of new onset MCD during pregnancy uncommon. Adults also tend to have a higher incidence of relapse and take longer to achieve remission. Our electron microscopy showed 40-50% podocyte effacement which could suggest secondary MCD however her history and genetic testing were negative. Although multiple therapeutic options for MCD exist, management in the adult and pregnant populations are not well defined. There have been reports of spontaneous remission of MCD however this appears to be rare and not well described. In our case at her two month postpartum follow up, she has stayed in remission since gestational week 18 without treatment, and highlights the lack of research regarding MCD management in adults, as well any additional accommodations for the pregnant population.