Steroid-Dependent Minimal Change Disease in an Adult Responsive to Rituximab
- Glomerular Diseases: Podocyte Biology - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1403 Podocyte Biology
- Assante, William Joseph, Westchester Medical Center Health Network, Valhalla, New York, United States
- Kapoor, Aromma, Westchester Medical Center Health Network, Valhalla, New York, United States
The patient is a 30M diagnosed at age 27 with minimal change disease. His clinical course was complicated by multiple relapses following an initial treatment with full dose steroids (60mg per day) per clinical guidelines. He ultimately progressed to steroid dependent disease. Consequently, the patient was prescribed Rituximab, to which he showed a clinical and serologic response, with almost full remission of proteinuria.
The patient was diagnosed with minimal change disease in 2019, and he was treated with a course of full dose steroids by his primary nephrologist. However, after steroids were tapered off, the patient suffered three more relapses of his minimal change disease over the course of the ensuing fourteen months. After the last relapse, steroids were unable to be weaned (remained on 5 mg PO daily). A CT scan of the chest returned unremarkable for lymphadenopathy or any findings suspicious for lymphoma.
The patient sought a second opinion with a nephrologist at Westchester Medical Center. Upon initial evaluation in November 2020, urine protein to creatinine ratio (UPCR) was 3mg/g, with creatinine 1.06. He continued the aforementioned maintenance dose of prednisone 5mg PO daily.
On follow-up in July 2021, the patient endorsed frothy urine, lower extremity swelling, and twenty pound weight gain. The patient had increased his dose of prednisone to 10mg PO daily prior to the appointment. Creatinine 0.86 and UPCR 4mg/g. Once again, he was started on full dose steroids for treatment, with subsequent improvement in proteinuria. However, by April 2022, the patient once again endorsed lower extremity swelling and frothy urine while on steroids.
A repeat biopsy was performed that showed minimal change disease, with 40-89% effacement of the podocyte foot processes.
The patient was subsequently given two doses of Rituximab 1gm IV for steroid dependent minimal change disease. Steroids were discontinued. Upon follow-up in February 2023, the patient's creatinine was 1.1 and UPCR 0.04mg/g.
Minimal change disease is a rare clinical entity in adult patients. The patient in this case presented with relapsing minimal change disease (confirmed by two separate biopsies) that ultimately became steroid dependent. This case provides an example of successful response to Rituximab as an alternate agent for minimal change disease in treatment resistant cases.