Tang Long, Cai Zhen, Wang Su-Xia, Zhao Wen-Jing
Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China.
Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China.
World J Clin Cases. 2022 Jun 16;10(17):5861-5868. doi: 10.12998/wjcc.v10.i17.5861.
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.
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.
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.
尽管微小病变性肾病（MCD）和局灶节段性肾小球硬化症（FSGS）被描述为肾病综合征（NS）的两种不同形式，但它们并非完全独立。我们报告一例从MCD转变为FSGS的患者病例，回顾相关文献，并探讨这两种疾病之间的关系。
一名42岁的男性焊工，因下肢水肿和血清肌酐升高就诊，根据实验室检查结果被诊断为NS和终末期肾病（ESKD）。该患者20年前曾因NS接受肾活检，结果显示为MCD，近期的第二次肾活检提示为FSGS。该患者为电焊工，血液中镉和铅含量过高。因此，我们怀疑其病情加重及ESKD的发生与金属肾毒性有关。该患者最终接受了肾脏替代治疗，并辞去了涉及长期接触金属的工作。在1年的随访期内，患者血液和尿液中的金属元素检测呈阴性，部分肾功能得以恢复。
MCD和FSGS可能是同一疾病的不同阶段。本病例中从MCD转变为FSGS表明疾病进展，这可能与患者职业导致的金属污染物超标有关。
