Kidney Week

Abstract: TH-PO0856

Coexistence of Minimal Change Disease and Acquired Thrombotic Thrombocytopenic Purpura: A Case Report

Session Information

• Glomerular Case Reports: Potpourri
  November 06, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Alsaedi, Zainulabdeen S, New York Presbyterian Queens, Flushing, New York, United States

Zainulabdeen S Alsaedi, MD

• Gajre, Ashwin, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, MH, India

Ashwin Gajre, MBBS

• Miqdad, Mohammed A., New York Presbyterian Queens, Flushing, New York, United States

Mohammed A. Miqdad, MD

• Alatta, Lina S., New York Presbyterian Queens, Flushing, New York, United States

Lina S. Alatta, MBBS

• Hulwi, Hasan, New York Presbyterian Queens, Flushing, New York, United States

Hasan Hulwi, MD

• Rodriguez, Oscar, New York Presbyterian Queens, Flushing, New York, United States

Oscar Rodriguez, MD

• Kuo, Sheng F., New York Presbyterian Queens, Flushing, New York, United States

Sheng F. Kuo, MD, FASN

Introduction

A case of coexisting minimal change disease (MCD) and acquired thrombotic thrombocytopenic purpura (TTP), highlighting a poorly understood and infrequently reported association

Case Description

A 61-year-old female presented with anasarca. Workup showed nephrotic proteinuria (PCR 6 g/g), hypoalbuminemia (1.3 g/dL), normal renal function, and normal echocardiogram. Kidney biopsy confirmed MCD. She achieved remission with steroids, tapered off over months. Weeks after stopping, she developed anuria and edema; creatinine rose to 10.3 mg/dL, requiring dialysis for 2 weeks. Prednisone 60 mg daily led to full recovery. A relapse during taper responded again to high-dose steroids. While in remission on 60 mg, she developed fever, headache, jaundice, and swelling. Labs (see table) showed anemia, schistocytosis, and thrombocytopenia. With a PLASMIC score of 6, PLEX and rituximab were initiated. ADAMTS13 activity <5% confirmed acquired TTP. Workup for autoimmune disease, infection, and malignancy was negative. She improved clinically and hematologically with treatment

Discussion

MCD and TTP are distinct immune-mediated conditions with possible overlap. MCD involves circulating factors, T cells, and possibly anti-nephrin antibodies; rituximab’s efficacy implicates B cells. TTP is caused by anti-ADAMTS13 antibodies, leading to platelet-rich microthrombi. Our patient developed TTP despite MCD remission on high-dose steroids, suggesting a steroid-resistant or separate immune pathway. She improved only with plasma exchange and rituximab. Similar reports (e.g., Tanaka et al., Cataland et al.) hint at shared mechanisms. Whether these diseases share a trigger or reflect predisposition remains unclear. This case highlights the need for vigilance even when one autoimmune process appears controlled

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025d151w1kt