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Spontaneous Remission Of Minimal Change Nephrotic Syndrome In An Elderly Man

Chiba, Y. 2021Other/Unknown

Chiba, Y., Nagasawa, T., Kin, S., Takahashi, K., Yoshida, M., Oe, Y., Okamoto, K., Sato, H., & Miyazaki, M. (2021). Spontaneous remission of minimal change nephrotic syndrome in an elderly man. CEN case reports, 10(2), 301–307. https://doi.org/10.1007/s13730-020-00554-x

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Abstract

Minimal change nephrotic syndrome (MCNS) cases achieving spontaneous remission without external factors are rarely reported. We report a case of MCNS that achieved spontaneous remission without external factors that triggered its onset. An 82-year-old male patient was admitted to the hospital for close examination of nephrotic syndrome. Renal biopsy was performed and MCNS was diagnosed. Owing to the patient's age and history of foot and microvascular arteriovenous thrombosis, we did not start immunosuppressive drugs, including steroids, and opted for conservative management. After conservative treatment, proteinuria gradually decreased, and the patient achieved complete remission. Given that the patient had a history of urinary protein and thrombosis, recurrence of MCNS was considered again this time. In addition, the involvement of external factors that trigger the onset of MCNS was not found. In conclusion, in elderly-onset MCNS, clinicians generally hesitate to initiate treatment with an immunosuppressive drug, containing steroids, because of its many complications. Thus, our data provide valuable insight into MCNS.

Case Details

Disease Location

Kidney

Personal Characteristics

82-year-old man. History of hypertension, type 2 diabetes, and atrial fibrillation, lower limb amputation due to acute arterial occlusion at the age of 68, and had left branch retinal vein occlusion at the age of 73

Clinical Characteristics

Referred with symptoms of edema, hypoalbuminemia, and urinary protein (up) that had worsened over the past 6 months. On examination, edema was seen over his face and both legs (from the foot to the knees). Laboratory findings led to the diagnosis of nephrotic syndrome. A percutaneous renal biopsy was performed. Electron microscopy demonstrated extensive foot process effacement, without deposits or basement membrane abnormalities. The diagnosis of minimal change nephrotic syndrome (mcns) was made. He was treated with an angiotensin receptor blocker and dietary and lifestyle modifications.

Remission Characteristics

Spontaneous complete remission was achieved after 3 months

Treatment & Mechanisms

Clinical Treatment

Biopsy, angiotensin receptor blocker.

Non-Clinical Treatment

Dietary and lifestyle modifications.