A unique characteristic of the response of
minimal-change disease (MCD) or focal and
segmental glomerulosclerosis (FSGS) to
steroid therapy is that the remission of
proteinuria occurs quickly, for example, within 4 - 6 weeks of the onset of
steroid therapy, even in those with severe
nephrotic syndrome. Remission of
proteinuria in MCD and FSGS can also occur spontaneously (not
steroid induced). However, spontaneous remission usually proceeds over several months or longer. Recently, there have been several reports that
abatacept can induce
proteinuria remission in MCD and FSGS. These claims, however, are dubious because either the remission occurred slowly over several months of
abatacept therapy, or remission occurred within a few weeks of
abatacept therapy, but the patient was also receiving
therapies that could have accounted for the remission of
proteinuria. Our case is unique in that his severe
steroid- and
cyclosporine-resistant MCD remitted acutely while receiving
abatacept, and there was no other plausible explanation for the acute remission of his MCD.
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