Ewha Med J.  2016 Oct;39(4):118-121. 10.12771/emj.2016.39.4.118.

A Patient with IgA Nephropathy: 5 Years after Complete Remission of Minimal Change Nephrotic Syndrome

• Kim JW
• Park JH
• Kim DH
• Kim HY
• Kim SH
• Park WD

• KMID: 2356383
• DOI: http://doi.org/10.12771/emj.2016.39.4.118

Abstract

A 37-year-old male patient was admitted with generalized edema as the main symptom. A blood test confirmed hypoalbuminemia and hyperlipidemia, and a urine test confirmed severe albuminuria. A renal biopsy was conducted, which revealed a diagnosis of minimal change disease. Although the patient experienced complete remission of minimal change nephrotic syndrome after oral prednisolone and cyclophosphamide treatment, he is readmitted due to bilateral leg edema 5 years later since minimal change nephrotic syndrome was completely cured. The patient is diagnosed with IgA nephropathy. Although the exact mechanisms of IgA nephropathy in this patient remain unclear, this case represents an extremely rare development, and is separate from the remission of minimal change nephrotic syndrome.

Keyword

Nephrotic syndrome; Lipoid nephrosis; IgA glomerulonephritis

MeSH Terms

Adult
Albuminuria
Biopsy
Cyclophosphamide
Diagnosis
Edema
Glomerulonephritis, IGA*
Hematologic Tests
Humans
Hyperlipidemias
Hypoalbuminemia
Immunoglobulin A*
Leg
Male
Nephrosis, Lipoid*
Nephrotic Syndrome
Prednisolone
Cyclophosphamide
Immunoglobulin A
Prednisolone

Figure

• 

  Fig. 1 Renal biopsy (H&E, ×400). (A) The H&E stained section (first biopsy) shows segmental sclerosis with increased dense eosinophilic mesangial matrix. (B) The second H&E stained section (second biopsy) demonstrates mesangial expansion with foamy cell collection. (C) The last periodic acid-Schiff (PAS) stained slide shows slight mesangial proliferation.

• 

  Fig. 2 Electron microscope findings (×400). (A, B) Initial biopsy reveals no definite electron-dense deposits. (C) The second biopsy shows a small electron-dense deposit at the mesangium with slight mesangial proliferation.

• 

  Fig. 3 Immunofluorescence (×400). The IgA immunofluorescence test reveals diffuse mesangial reactivity with 3+ intensity.

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