Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
Department of Community Medical Support Tohoku Medical Megabank Organization, Tohoku University School of Medicine, Sendai, Miyagi, Japan.
CEN Case Rep. 2021 May;10(2):301-307. doi: 10.1007/s13730-020-00554-x. Epub 2021 Jan 4.
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.
特发性微小病变肾病综合征(MCNS)病例在无外部因素触发的情况下自发缓解的情况很少见。我们报告了一例特发性 MCNS 病例,该病例在无外部因素触发的情况下自发缓解。一名 82 岁男性患者因肾病综合征接受入院密切检查。进行了肾活检,诊断为 MCNS。由于患者年龄较大,且有足部和微血管动静脉血栓形成病史,我们没有开始使用免疫抑制剂,包括类固醇,并选择了保守治疗。保守治疗后,蛋白尿逐渐减少,患者达到完全缓解。鉴于该患者有蛋白尿和血栓形成病史,此次再次考虑到 MCNS 复发。此外,未发现触发 MCNS 发病的外部因素的参与。总之,在老年起病的 MCNS 中,由于类固醇等免疫抑制剂治疗的并发症较多,临床医生通常会犹豫是否开始治疗。因此,我们的数据为 MCNS 提供了有价值的见解。