Transition from minimal change disease to focal segmental glomerulosclerosis related to occupational exposure: A case report

Abstract

BACKGROUND Although minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) have been described as two separate forms of nephrotic syndrome (NS), they are not completely independent. We report a case of a patient transitioning from MCD to FSGS, review the literature, and explore the relationship between the two diseases. CASE SUMMARY A 42-year-old male welder, presenting with lower extremity edema and elevated serum creatinine, was diagnosed with NS and end-stage kidney disease (ESKD) based on laboratory test results. The patient had undergone a kidney biopsy for NS 20 years previously, which indicated MCD, and a second recent kidney biopsy suggested FSGS. The patient was an electric welder with excessive levels of cadmium and lead in his blood. Consequently, we suspect that his aggravated pathology and occurrence of ESKD were related to metal nephrotoxicity. The patient eventually received kidney replacement therapy and quit his job which involved long-term exposure to metals. During the 1-year follow-up period, the patient was negative for metal elements in the blood and urine and recovered partial kidney function. CONCLUSION MCD and FSGS may be different stages of the same disease. The transition from MCD to FSGS in this case indicates disease progression, which may be related to excessive metal contaminants caused by the patient’s occupation.

A pilot study of anti‐nephrin antibodies in podocytopaties among adults

“…Given the intrinsic ambiguity in distinguishing between MCD and FSGS, there exists the potential for missed FSGS cases, and the consideration that MCD could represent an early stage of FSGS. [23][24][25] To navigate this complexity, we categorized MCD/FSGS patients based on their response to immunosuppressive therapy, specifically to steroid therapy or cyclosporine. Intriguingly, despite these classifications, we did not ascertain any significant correlation between the initial levels of antibodies targeting nephrin and the response to immunosuppressive therapy.…”

“…In our study, a notable 89% of MCD patients and 40% of FSGS patients exhibited steroid‐sensitive and steroid‐dependent NS. Given the intrinsic ambiguity in distinguishing between MCD and FSGS, there exists the potential for missed FSGS cases, and the consideration that MCD could represent an early stage of FSGS 23–25 . To navigate this complexity, we categorized MCD/FSGS patients based on their response to immunosuppressive therapy, specifically to steroid therapy or cyclosporine.…”

Nephrotic Syndrome Associated With Heavy Metals Exposure: A Case Report and Literature Review

“…The patient worked as an electrical welder and had elevated blood levels of cadmium and lead. He resigned from his job due to possible toxicity, and after one year of follow-up, the patient recovered partial kidney function with negative screening for the aforementioned metals in blood and urine [52]. Furthermore, an observational epidemiologic study compared the occupations and toxic exposures of 100 patients with histologically confirmed MN with those of the general population.…”

Current understanding of the molecular mechanisms of circulating permeability factor in focal segmental glomerulosclerosis

“…Researchers have argued that MCD and FSGS may represent opposite ends of a spectrum, with FSGS as the more severe phenotype associated with a poor prognosis and frequent progression to renal failure ( 11 – 13 ).…”