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Abstract: FR-PO680

Minimal Change Disease Superimposed on Diabetic Nephropathy: A Very Rare Clinical Occurrence

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Pariswala, Tanazul T., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, United States
  • Bashir, Khawaja Arsalan, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, United States
  • Shah, Hitesh H., Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, United States
Introduction

Diabetic nephropathy (DN) is a leading cause of ESKD in the US. Patients with DN usually develop progressive proteinuria and kidney failure over the years. A subset of patients with DN may develop nephrotic syndrome. However, sudden onset of nephrotic syndrome in patients with history of diabetes mellitus (DM) may suggest the presence of nondiabetic kidney disease. Here, we present an interesting and challenging case of minimal change disease superimposed on DN.

Case Description

78-year-old male with type 2 DM presented to our hospital for worsening bilateral LE swelling and significant weight gain. Of note, pt. was seen in another hospital approximately 3 months ago for similar complaints. During that hospital stay, pt. was found to have nephrotic syndrome. Kidney biopsy performed at the time showed diffuse effacement of epithelial foot processes consistent with minimal change disease (MCD) and mild diffuse diabetic glomerulosclerosis. Pt. was not initiated on oral corticosteroid therapy for MCD at the time as he had lab findings of latent TB. Pt. was initiated on oral rifampin as outpatient. Pt. however took rifampin for only 2 weeks as he felt that it contributed to his worsening LE swelling. On presentation to our hospital, pt. found to have significant bilateral LE edema and nephrotic syndrome. Urine TP/CR ratio was 10 and serum albumin was 1.5. Scr was elevated at 2.9 on admission, peaked to 4.8 during hospital stay. Pt. initiated on IV diuretic therapy with good clinical response. ID was initially consulted for concerns for latent TB. Pt. found to have abnormal lung findings on CT scan hence pulmonary team was also consulted. Pt. underwent bronchoscopy. BAL fluid studies were negative for AFB and active TB was ruled out. Pt. subsequently initiated on oral rifampin (for latent TB) and oral prednisone therapy (for MCD). Scr decreased to 4.2 prior to discharge. Pt. was discharged on oral diuretics, rifampin, and prednisone with advice to follow-up in nephrology clinic.

Discussion

While nephrotic syndrome has been described in patients with DN, MCD superimposed on DN has been rarely reported. Sudden onset of nephrotic syndrome should raise suspicion for nondiabetic kidney disease in patients with DM. Our case also highlights the importance of kidney biopsy in diabetic patients presenting with sudden onset nephrotic syndrome and kidney failure.