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Kidney Week

Abstract: PO1674

Minimal Change Disease as a Sequela of Psoriasis in an Adult

Session Information

Category: Glomerular Diseases

  • 1204 Podocyte Biology

Authors

  • Debnath, Priya, New York City Health and Hospitals Coney Island, Brooklyn, New York, United States
  • Okoye, Chibuzo C., New York City Health and Hospitals Coney Island, Brooklyn, New York, United States
  • Zia, Arham, New York City Health and Hospitals Coney Island, Brooklyn, New York, United States
  • Roy Chaudhury, Samiran, New York City Health and Hospitals Coney Island, Brooklyn, New York, United States
  • Frolova, Elena, New York City Health and Hospitals Coney Island, Brooklyn, New York, United States
Introduction

Minimal change disease (MCD) is usually found in children but can be an uncommon presentation in adults. Relation to psoriasis has not been significantly established even though the latter has been associated with kidney disease such as IgA nephropathy, focal segmental glomerulosclerosis leading to kidney failure. This is an interesting case given that this is a young patient with psoriasis presenting with a flare in the setting of newly diagnosed MCD.

Case Description

A 34-year-old male with history of psoriasis presented with severe body edema after psoriatic flare two weeks prior admission. He was found to have exceptionally low serum albumin of 1.4g/dL, massive proteinuria with spot urine protein creatinine ratio of 7.6 and significant hyperlipidemia. Protein electrophoresis did not show glomerular pathology or spikes in proteins and extensive serological workup was normal. Kidney biopsy reported MCD. Patient improved quickly with steroids of 1mg/kg/day, IV furosemide and albumin infusion. Six months later, the patient was readmitted with new psoriasis flare and again nephrotic syndrome with 7.2g of proteinuria. His symptoms resolved quickly with same treatment used on the first admission. Follow up in clinic one-month post discharge showed normal renal function with proteinuria now at 100mg/day.

Discussion

While there has been evidence of link between psoriasis and kidney disease, finding of MCD is a unique development. The idea can be postulated that since psoriasis is a disease due to dysfunction of T-cells among other causes, a flare can be the initiating event leading to dysregulation of an otherwise stable immune system. This T-cell dysregulation has also been noted in MCD. The underlying cause of MCD is not clear. However, a lot of studies suggest that T-cell dysfunction is one of the implicated agents, known for cell destruction, causing damage to the glomerular membrane leading to the loss of proteins. The rarity of this case belies the complexity of the immunological process leading to the presentation and further research needs to be done to document and establish this as the pathologic process linking the two diseases.