• Aki Kojima, Takahiro Uchida, Kentaro Sugisaki, Minami Koizumi, Ken Aoki, Mitsuya Mukae, Muneharu Yamada, and Takashi Oda.
• Department of Nephrology and Blood Purification, Kidney Disease Center, Tokyo Medical University Hachioji Medical Center, Hachioji, Tokyo, Japan.
• Medicine (Baltimore). 2023 Oct 13; 102 (41): e35470e35470.

RationaleA predominant Th2 immune response is suggested in the pathogenesis of both minimal change disease (MCD) and membranous nephropathy (MN); however, consecutive development of the 2 diseases in a patient is extremely rare.Patient ConcernA Japanese man, who developed nephrotic syndrome in his 50s and was diagnosed with MCD by renal biopsy, experienced a relapse of proteinuria approximately 3 years later during long-term steroid treatment. Since the proteinuria was resistant to increase in steroid dosage, repeat renal biopsy was performed, which revealed a small amount of glomerular subepithelial immune deposits containing immunoglobulin (Ig)G (dominantly IgG4). Immunostaining for thrombospondin-type-1-domain-containing-7A (THSD7A) was positive on the glomerular capillary walls, whereas that for other causative antigens of MN, such as phospholipase A2 receptor or neural epidermal growth factor-like 1 protein, was negative. Detailed examination found no associated condition, including malignancies and allergic diseases.DiagnosisThe diagnosis of THSD7A-associated idiopathic MN was made.Interventions And OutcomesHe received further increased dose of steroids. Thereafter he maintained clinical improvement because his urinary protein level was decreased.LessonsThe present case suggested that histological transition from MCD to MN is possible and repeat biopsy would be crucial for accurate diagnosis.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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