Abstract: FR-PO0732
Dusting of Podocytes in Late-Onset Minimal Change Disease: An Unusual Histologic Pattern Suggesting Antinephrin-Mediated Podocytopathy on Kidney Biopsy
Session Information
- Glomerular Diseases: Membranous Nephropathy, FSGS, and Podocytopathies
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Irfan, Babar, SUNY Upstate Medical University, Syracuse, New York, United States
- Awais, Muhammad, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
- Rehman, Tanzeel, SUNY Upstate Medical University, Syracuse, New York, United States
- Mobeen, Haris, SUNY Upstate Medical University, Syracuse, New York, United States
Introduction
Minimal change disease (MCD) is a form of podocytopathy. Recent evidences support anti-nephrin autoantibodies role in the pathogenesis of MCD with distinctive feature on immunoflourescence (IF) punctuate fine granular IgG deposition along podocytes, termed as dusting, suggest antibody mediated podocyte injury.
Case Description
A 65 year old male presented with generalized edema and nephrotic-range proteinuria. Full serologic testing were negative. IF showed weak fine granular dusting of IgG staining podocytes. Podocyte IgG dusting indicate anti-nephrin antibody mediated podocytopathy. Treated with high dose oral prednisone. Complete remission achieved at 2 month follow up with urine protein-to-creatinine ratio declining from 14.41 mg/mg to 0.15 mg/mg.
Discussion
IgG podocyte dusting in IF is an evolving histological marker. Confirmation with serum anti-nephrin antibody testing was not performed due to limited accessiblity, reflecting broader diagnostic gap in clinical settings. Recognition of this IF is clinically important as it may aid in targeted therapies in steroid resistant or intolerant patients.
Biopsy findings
| Microscopy | Key Findings |
| Light Microscopy | 18 glomeruli; 17% global glomerulosclerosis; mild IFTA; no crescents or hypercellularity |
| Immunofluorescence | Negative for significant immune complex or paraprotein deposits but positive IgG podocyte dusting |
| Electron Microscopy | Diffuse (~90%) effacement of podocyte foot processes; no electron-dense deposits |
IF: IgG Dusting of podocytes
EM: Effacement of foot processess