title: A case of minimal change nephrotic syndrome with immunoglobulin A nephropathy transitioned to focal segmental glomerulosclerosis.
abstract: A 50-year-old woman with a 1-month history of lower extremity edema and a 5 kg weight increase was admitted to our hospital with suspected nephrotic syndrome in October 1999. Urine protein level was 3.5 g per day, 10-15 erythrocytes in urine per high-power field, and serum albumin level 2.5 g/dl. Furthermore, an accumulation of pleural effusion was confirmed by chest X-ray. The results of a renal biopsy indicated slight mesangial proliferation in the glomeruli by light microscopy, and an immunofluorescence study confirmed the deposition of immunoglobulin (Ig) A and C3 in the mesangial area. Diffuse attenuation of foot processes and dense deposits in the mesangial area were observed by electron microscopy. Treatment with 40 mg/day of prednisolone was effective, and proteinuria was negative 1 month later. Because of this course, we diagnosed minimal change nephrotic syndrome complicated by mild-proliferative IgA nephropathy. In November 2000, there was a relapse of nephrotic syndrome, which was believed to be induced by an influenza vaccination, but response to increased steroid treatment was favorable, and proteinuria disappeared on day 13 of steroid increase. A second relapse in May 2001, showed steroid resistance with renal insufficiency, and an increase in the selectivity index to 0.195. Light microscopy revealed focal sclerotic lesions of the glomeruli, and an immunofluorescence study revealed attenuation of mesangial IgA and C3 deposition. These findings led to the diagnosis that minimal change nephrotic syndrome had transitioned to focal segmental glomerulosclerosis, whereby mesangial IgA deposition was reduced by immunosuppressive treatment. Subsequently, her renal function gradually worsened to the point of end-stage renal failure by 27 months after the second relapse of nephrotic syndrome.
authors.affiliation: Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan.
authors.forename: Misaki
authors.initials: M
authors.lastname: Hirose
authors.forename: Tomoya
authors.initials: T
authors.lastname: Nishino
authors.forename: Tadashi
authors.initials: T
authors.lastname: Uramatsu
authors.forename: Yoko
authors.initials: Y
authors.lastname: Obata
authors.forename: Mineaki
authors.initials: M
authors.lastname: Kitamura
authors.forename: Tayo
authors.initials: T
authors.lastname: Kawazu
authors.forename: Masanobu
authors.initials: M
authors.lastname: Miyazaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Taguchi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
mesh_terms: D005260:Female; D005922:Glomerulonephritis, IGA / Q000150:complications* / Q000188:drug therapy; D005923:Glomerulosclerosis, Focal Segmental / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000150:complications* / Q000188:drug therapy; D011239:Prednisolone / Q000627:therapeutic use
chemical_list: D011239:Prednisolone