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Transition from minimal change disease to focal segmental glomerulosclerosis related to occupational exposure:A case report

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World Journal of Clinical Cases 2022年第17期10卷 5861-5868页

作者： Long Tang Zhen Cai Su-Xia Wang Wen-Jing Zhao Department of Nephrology Beijing Hospital of Traditional Chinese MedicineCapital Medical UniversityBeijing 100010China Laboratory of Electron Microscopy Pathological CenterPeking University First HospitalPeking University Institute of NephrologyBeijing 100034China

BACKGROUND Although minimal change disease(MCD)and focal segmental glomerulosclerosis(FSGS)have been described as two separate forms of nephrotic syndrome(NS),they are not completely *** report a case of a patient transitioning from MCD to FSGS,review the literature,and explore the relationship between the two *** SUMMARY A 42-year-old male welder,presenting with lower extremity edema and elevated serum creatinine,was diagnosed with NS and end-stage kidney disease(ESKD)based on laboratory test *** patient had undergone a kidney biopsy for NS 20 years previously,which indicated MCD,and a second recent kidney biopsy suggested *** patient was an electric welder with excessive levels of cadmium and lead in his ***,we suspect that his aggravated pathology and occurrence of ESKD were related to metal *** patient eventually received kidney replacement therapy and quit his job which involved long-term exposure to *** the 1-year follow-up period,the patient was negative for metal elements in the blood and urine and recovered partial kidney *** MCD and FSGS may be different stages of the same *** transition from MCD to FSGS in this case indicates disease progression,which may be related to excessive metal contaminants caused by the patient’s occupation.

关键词： minimal change disease Focal segmental glomerulosclerosis Occupational exposure Cadmium Lead Case report

Fulminant ulcerative colitis associated with steroid-resistant minimal change disease and psoriasis: A case report

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World Journal of Gastroenterology 2007年第29期13卷 4022-4024页

作者： Ka-Ho Lok Hiu-Gong Hung Wai-Man Yip Kin-Kong Li Kam-Fu Li Ming-Leung Szeto Division of Gastroenterology and Hepatology Department of Medicine and Geriatrics Tuen Mun Hospital Tsing Chung Koon Road Tuen Mun Hong Kong China

A 43-year-old Chinese patient with a history of psoriasis developed fulminant ulcerative colitis after immunosuppressive therapy for steroid-resistant minimal change disease was stopped. minimal change disease in association with inflammatory bowel disease is a rare condition. We here report a case showing an association between ulcerative colitis, minimal change disease, and psoriasis. The possible pathological link between 3 diseases is discussed.

关键词： Ulcerative colitis Inflammatory bowel disease minimal change disease

Adult minimal change disease:Clinicopathologic characteristics,treatment response and outcome at a single center in Pakistan

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World Journal of Nephrology 2024年第4期13卷 73-80页

作者： Shaheera Shakeel Rahma Rashid Nazarul H Jafry Muhammed Mubarak Department of Histopathology Sindh Institute of Urology and TransplantationKarachi 74200SindhPakistan Department of Nephrology Sindh Institute of Urology and TransplantationKarachi 74200SindhPakistan

BACKGROUND minimal change disease(MCD)is a significant cause of idiopathic nephrotic syndrome(INS)in adults,representing approximately 10%-15% of INS *** data is scanty on clinicopathological features,treatment responses,and long-term outcomes of MCD in *** To determine the clinicopathologic characteristics,treatment responses,and medium-term outcomes of adult patients with MCD in *** This retrospective cohort study included all adult patients with biopsy-proven MCD treated at the adult nephrology clinic,Sindh institute of urology and transplantation,between January 2010 and December *** data was retrieved from the original renal biopsy request forms in the histopathology archives and the case *** on demographics,clinical presentation,laboratory findings,treatment regimens,and outcomes were collected and *** remission(CR),partial remission(PR),relapse,and steroid resistance were defined according to standard *** analyses were performed using statistical product and service solutions,Version *** The study cohort included 23 adults[15(65.2%males),mean age 26.34±10.28 years].Hypertension was found in 7(30.4%)and microscopic hematuria in 10(43.4%)of *** findings revealed a mean serum creatinine of 1.03±1.00 mg/dL,mean serum albumin of 1.94±0.90 g/dL and mean 24-hour urinary proteins of 4.53±2.43 *** mean follow-up time was 38.09±22.3 *** with steroids was effective in 16/18(88.8%)of patients,with 10/16(62.5%)achieving CR and 6/16(37.5%)achieving *** patients were resistant to steroids and required second-line immunosuppressive *** occurred in 4/20(19.04%)of patients,with a mean time to first relapse of 6.5±3.31 *** the last follow-up,18/20(85.7%)of patients were in remission,and 16/20(76.1%)maintained normal renal *** patients progressed to end-stage renal disease or *** MCD in adults shows a favorable response to steroi

关键词： minimal change disease Nephrotic syndrome Adults Steroid therapy Immunosuppression Clinical outcomes Pakistan

Clinical features of acute kidney injury in patients with nephrotic syndrome and minimal change disease:a retrospective,cross-sectional study

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Chinese Medical Journal 2021年第2期134卷 206-211页

作者： Shu-Peng Lin Feng-Ge Zhu Jin-Ling Meng Xiao-Wei Sun Jing Cui Shuang Liang Zhong Yin Xue-Feng Sun Guang-Yan Cai Department of Nephrology Chinese People’s Liberation Army General HospitalChinese People's Liberation Army Institute of NephrologyState Key Laboratory of Kidney Diseases(2011DAV00088)National Clinical Research Center for Kidney DiseasesBeijing Key Laboratory of Kidney DiseasesBeijing 100853China

Background:minimal change nephropathy(MCD)is a common pathological type of nephrotic syndrome and is often associated with acute kidney injury(AKI).This study aimed to investigate the clinical characteristics and related factors of AKI in patients with MCD and nephrotic ***:Patients from Chinese People’s Liberation Army General Hospital who were diagnosed with pathological renal MCD with clinical manifestations of nephrotic syndrome were included from January 1,2013 to December 31,*** diagnosed with membranous nephropathy(MN)by renal biopsy from January 1,2013 to December 31,2017 are included as a control *** retrospectively analyzed the clinical and pathological characteristics of patients as well as the percentages and clinical characteristics of AKI in different age *** assessed the correlation of pathological characteristics with serum creatinine using multivariate linear regression ***:A total of 367 patients with MCD were included in the analysis,with a sex ratio of 1.46:1(male:female)and an age range of 6 to 77 *** all the patients,109 developed AKI(29.7%),and of these patients,85 were male(78.0%).In the 586 patients with MN,27(4.6%)patients developed *** percentage of AKI in MCD patients was significantly higher than that in MN patients(χ^(2)=41.063,P<0.001).The percentage of AKI increased with age in the MCD *** percentage of AKI in patients aged 50 years or older was 52.9%(46/87),which was significantly higher than that[22.5%(63/280)]in patients under 50 years(χ^(2)=6.347,P=0.013).We observed statistically significant differences in age(43[27,59]years vs.28[20,44]years,Z=5.487,P<0.001),male(78.0%vs.51.4%,χ^(2)=22.470,P<0.001),serum albumin(19.9±6.1 g/L vs.21.5±5.7 g/L,t=2.376,P=0.018),serum creatinine(129.5[105.7,171.1]μmol/L vs.69.7[57.7,81.9]μmol/L,Z=14.190,P<0.001),serum urea(10.1[6.2,15.8]mmol/L vs.4.7[3.6,6.4]mmol/L,Z=10.545,P<0.001),IgE(266.0[86.7,963.0]IU/ml vs.142.0[35.3,516.5

关键词： minimal change disease Nephrotic syndrome Acute kidney injury

New sights into new-onset and relapsed minimal change disease post COVID-19 vaccination:A systemic review of the clinical characteristics and underlying pathogenesis

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Rheumatology & Autoimmunity 2024年第3期4卷 145-155页

作者： Jiarong Liu Gaosi Xu Department of Nephrology The Second Affiliated Hospital of Nanchang UniversityNanchangChina Department of Endocrinology and Metabolism The First Affiliated Hospital of Nanchang UniversityNanchangChina

Background:minimal change disease(MCD)following coronavirus disease 2019(COVID-19)vaccination has been increasingly reported;however,the clinical characteristics and pathogenesis of patients with MCD have not been thoroughly ***:A systematic literature search of published data up until May 10,2023,was conducted using the PubMed,Embase,Cochrane Library,Web of Science,and SinoMed *** patients diagnosed by renal biopsy following COVID-19 vaccination were analyzed with the largest sample size to ***:A total of 85 patients were included in the present statistical analysis,including 50 new-onset and 35 relapsed MCD subjects following COVID-19 *** with new-onset MCD patients,the relapsed patients had previously suffered from one or two other diseases(12/50 vs.34/35,p<0.001).The laboratory results indicated that new-onset MCD was more serious than MCD relapse,as evidenced by higher serum creatinine(p=0.036)and urinary protein levels(p<0.001),along with lower levels of serum albumin(p<0.001).The new-onset subjects responded to corticosteroids alone,while the relapsed patients acquired combined therapies involving immunosuppressants and steroids(p<0.001).Compared with MCD onset after two vaccine doses,those who immediately flared after the first vaccination had more comorbidities(p=0.011).Comparatively,the first dose-onset patients showed a higher response rate to treatments than the second dose-onset patients(44/50 vs.22/35,p=0.017).Conclusions:New-onset MCD was more severe than relapsed MCD in terms of laboratory results and clinical manifestations after COVID-19 ***,combining both corticosteroid therapy and immunosuppressive treatment yields an effective approach to managing the condition.

关键词： COVID-19 minimal change disease SARS-CoV-2 vaccination

The Beneficial Effect of Combination of Mycophenolate with Low-Dose Corticosteroids and Calcineurin-Inhibitor as Well as Angiotensin-Converting Enzyme Inhibitor or Angiotensin II Blocker in Induction and Maintenance of Remission in Corticosteroid- and Rituximab-Resistant minimal change Nephrotic Syndrome in Adults

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Open Journal of Nephrology 2022年第1期12卷 15-22页

作者： Kamel El-Reshaid Shaikha Al-Bader Hossameldin Tawfik Sallam Department of Medicine Faculty of Medicine Kuwait University Kuwait city Kuwait Department of Medicine Nephrology Unit Amiri Hospital Ministry of Health Kuwait city Kuwait

Management of steroid-resistant minimal change disease remains elusive with international guidelines suggesting high-dose corticosteroids and/or Calcineurin inhibitors for months similar to those with refractory idiopathic FSGS. Unfortunately, with such approach, the overall remission rates were 47% - 66%. Moreover, complete remission rates were 32% - 47% and partial remission ones were 19% - 29%. Those limited options of treatment and their poor outcomes led us to conduct the present study to assess the efficacy and safety of a new combined drug-therapy at induction and subsequent maintenance of such disease. The regimen consisted of an initial induction phase of 3-month Prednisone, Calcineurin-inhibitor, Mycophenolate and ACEI/ARB. The latter was followed by a maintenance phase of minimal dose Prednisone and nearly 1/2 the induction dose of Calcineurin inhibitors to decrease their long-term side effects. The results were satisfactory with 14 of the 22 patients, had complete remission. Moreover, 5 patients manifested partial remission and only 3 did not respond. Creatinine clearance was maintained in patients with complete remission yet, was mildly reduced in the partial and non-responsive ones. The safety and efficacy of such new combined drug-therapy provide new tool and future prospective in management of such relentless disease.

关键词： ACEI ARB Calcineurin Inhibitors Cyclosporine A minimal change disease Mycophenolate Nephrotic Syndrome Prednisone Tacrolimus

Children with Steroid-resistant Nephrotic Syndrome:Long-term Outcomes of Sequential Steroid Therapy

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Biomedical and Environmental Sciences 2016年第9期29卷 650-655页

作者： ZHANG Hui WANG Zheng DONG Li Qun GUO Yan Nan The department of Pediatrics West China Second University Hospital of Sichuan University Key Laboratory of Birth Defects and Related diseases of Women and Children(Sichuan University) Ministry of Education

Objective This study aimed to investigate the long-term outcomes in children with steroid-resistant nephrotic syndrome （SRNS）, who received methylprednisolone pulse therapy （MPT）-based sequential steroid therapy. In particular, we aimed to observe whether these patients had a high risk of adverse events. Methods We conducted a retrospective study over a 5-year period. The long-term outcomes for children with SRNS receiving sequential therapy were observed. Results Sixty-three children were diagnosed with SRNS and underwent MPT-based sequential steroid therapy. Thirty-five （55.6%） achieved complete or partial remission, 19 （30.2%） of whom were in remission even after treatment cessation at last review. The mean time to initial remission after MPT was 24.3±13.1 days. Forty-nine children （77.8%） experienced relapses, of whom 31 （49.2%） demonstrated a frequent relapsing course. Adverse effects relevant to MPT were generally mild and infrequent. Five patients （7.9%） complained of vomiting or nausea during MPT infusion; 25 （39.7%） experienced excessive weight gain and developed an obvious Cushingoid appearance; and 26 （41.3%） had poor growth associated with long-term steroid use. Twenty-eight patients （44.4%） failed to respond to MPT, of whom 21 （33.3%） achieved complete or partial remission with immunosuppressive agents. Conclusion MPT-based sequential steroid therapy appears to be a safe and effective method for inducing rapid remission in childhood SRNS. Further clinical studies are needed to comprehensively evaluate this therapy.

关键词： Methylprednisolone Steroid resistance minimal change disease Focal segmental81omerulosclerosis Clinical outcome

Reversible Chronic Interstitial Nephritis Induced by Tacrolimus —Tacrolimus Chronic Interstitial Nephritis

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Open Journal of Nephrology 2023年第1期13卷 1-5页

作者： Kamel El-Reshaid Shaikha Al-Bader Department of Medicine Faculty of Medicine Kuwait University Kuwait City Kuwait Department of Medicine Nephrology Unit Amiri Hospital Ministry of Health Kuwait City Kuwait

Calcineurin inhibitors (CNI) are potent immunosuppressive agents in prophylaxis against graft rejection and autoimmune diseases including primary glomerulopathies. Previous research showed reversible;acute afferent arteriolar vasculopathy and irreversible chronic interstitial fibrosis associated with CNI nephrotoxicity. In this case report we describe a patient, with minimal change disease, that had developed chronic and progressive renal disease while receiving therapeutic dose of Tacrolimus. His serum creatinine had reached 537 umol/L and his nephrotic state worsened. Kidney biopsy showed chronic interstitial nephritis. Tacrolimus was discontinued and he was treated with 1 mg/kg prednisone in addition to Mycophenolate mofetil (MMF) 1 g twice daily. By the 2nd month;serum creatinine returned to normal and by the 3rd month serum albumin too. After 1 month of therapy;the dose of Prednisone was tapered down gradually till 5 mg daily by the end of 3rd month. Moreover, the dose of MMF was reduced to 500 mg X2 by the end of 3rd month. After 2 years of follow up;he remained stable and without relapse of NS or renal failure. In conclusion, reversible renal disease, due to chronic interstitial nephritis can be induced by CNI which is amenable to treatment with Prednisone and MMF.

关键词： Calcineurin Inhibitors Mycophenolate Mofetil Tacrolimus Interstitial Nephritis minimal change disease Nephrotic Syndrome

Idiopathic Adult Nephrotic Syndrome: A Clinicopathological Study and Response to Steroid in a Sub-Saharan African Country

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Open Journal of Nephrology 2016年第2期6卷 61-65页

作者： Maria Faye Ahmed Tall Lemrabott Mouhamadou Moustapha Cisse Jean De Dieu Nzambaza Cherif Mouhamed Dia Sidy Mohamed Seck Khodia Fall Moustapha Faye Elhadji Fary Ka Abdou Niang Boucar Diouf Department of Nephrology Aristide Le Dantec University Hospital Dakar Senegal Anatomo-Pathology Laboratory Grand-Yoff General Hospital Dakar Senegal Faculty of Medicine Gaston Berger University Saint-Louis Senegal

Introduction: Idiopathic nephrotic syndrome represents 25% to 30% of glomerulonephritis in adults. These glomerulonephritides are responsible of about the half of chronic kidney failure examined as well in United States as in Europe or Africa. The aim of this study was to determine the anatomoclinic, therapeutic and progression patterns of idiopathic nephritic syndrome in Dakar. Patients and Methods: It is a retrospective ten-year study in the nephrology department of Aristide Le Dantec Hospital. Patients with idiopathic nephrotic syndrome were included. We analyzed anatomoclinic, therapeutic and progression data of idiopathic nephrotic syndrome. Results: On 202 patients with nephrotic syndrome, 156 (77%) were primitive. The mean age was 29.7 ± 12 years with a sex ratio of 2.4. Edema was found in 98 patients (62.8%) and hypertension in 63 patients (40%). The mean proteinuria was 6.8 ± 4.8 g/24h. Histologic lesions found at renal biopsy were focal segmental glomerulosclerosis in 71 patients (45.5%), minimal change disease in 68 patients (43.5%) and membranous nephropathy in 8 patients (5%). 134 patients (85.8%) received steroids alone, 12 patients (7.6%) received cyclophosphamide and 4 patients (2.5%) azathioprine in association with steroids. 44 patients (28.2%) reached remission. The factors of poor prognosis were: age, above 40 years, proteinuria above 10 g/24h, existence of renal failure at admission, absence of use of steroids therapy. Conclusion: This study shows that idiopathic nephrotic syndrome is frequent in our country with a prevalence of 77%. The most common lesion found at the renal biopsy is the focal segmental glomerulosclerosis. Remission is found only in 28% which is very low. 33% of patients progress towards chronic kidney disease due to the lack of early diagnosis and the use of traditional medicine.

关键词： Idiopathic Nephrotic Syndrome Focal Segmental Glomerulosclerosis minimal change disease Membranous Glomerulonephritis