Kidney Week

Abstract: FR-PO0719

Remission of Minimal Change Disease During Acute Measles Infection

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

• Alotaibi, Khalid Ayidh, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia

Khalid Ayidh Alotaibi, MBBS

• Tawhari, Mohammed Hadi, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia

Mohammed Hadi Tawhari, MD, MBBS, MEd, MSc, FASN

• Alsadhan, Abdulmajeed Abdullah, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia

Abdulmajeed Abdullah Alsadhan, MD

• Alzahrani, Nora Mohsin M, King Abdulaziz Medical City in Riyadh, Riyadh, Riyadh Province, Saudi Arabia

Nora Mohsin M Alzahrani, MD

Introduction

Minimal change disease (MCD) is characterized by relapsing nephrotic syndrome and is believed to be related to immune dysregulation, although the exact mechanism remains unclear.Viral infections are well known to trigger relapses; however, remission during acute infection is rarely seen in the post-vaccination era.

Case Description

A 27-year-old woman, with childhood onset steroid-sensitive MCD in long-term remission without immunosuppression since 2018, presented with a history of fever, respiratory symptoms, and a generalized maculopapular rash with buccal mucosal lesions.
Laboratory evaluation confirmed nephrotic relapse with massive proteinuria exceeding quantification, serum albumin of 20 g/L, and preserved kidney function. Respiratory viral multiplex was positive for RSV, likely triggering the relapse. Given erythematous maculopapular rash and Koplik spots, measles serology was positive for IgM antibodies, confirming concomitant acute measles infection. Her measles vaccination status was unknown.
Prednisolone (1 mg/kg/day) was administered for one day then stopped after confirming acute measles infection due to concerns about worsening viral disease. She was managed supportively. At two-week follow-up, she achieved complete remission, proteinuria had resolved, serum albumin normalized to 36 g/L, and kidney function remained stable.

Discussion

This case highlights a rare but previously reported observation — remission of MCD during acute measles infection rather than the usual infection-associated relapse.
MCD is thought to result from immune dysregulation involving T cell pathways, although recent evidence suggests more complex interactions that may also involve B cells and circulating permeability factors. Measles infection induces temporary suppression of cell-mediated immunity, which may reduce the immune activity involved in podocyte injury and allow remission to occur. In our case, RSV infection was a likely trigger for relapse, while measles infection may have contributed to subsequent remission.
The timing of remission alongside acute measles infection supports an immunomodulatory effect, although a direct causal relationship cannot be established. Similar observations have been reported in the pre-vaccination era.
This case highlights the multifactorial nature of immune dysregulation in MCD and its relationship with disease activity, where changes in immunological state can influence the clinical course.