Histological transition from minimal change disease to THSD7A-associated membranous nephropathy in a patient receiving long-term steroid treatment: A case report.

Abstract

RATIONALE:

A 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 CONCERN:

A 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.

DIAGNOSIS:

The diagnosis of THSD7A-associated idiopathic MN was made.

INTERVENTIONS AND OUTCOMES:

He received further increased dose of steroids. Thereafter he maintained clinical improvement because his urinary protein level was decreased.

LESSONS:

The present case suggested that histological transition from MCD to MN is possible and repeat biopsy would be crucial for accurate diagnosis.

• Authors: Aki Kojima, Takahiro Uchida, Kentaro Sugisaki, Minami Koizumi, Ken Aoki, Mitsuya Mukae, Muneharu Yamada, Takashi Oda
• Journal: Medicine (Medicine (Baltimore)) Vol. 102 Issue 41 Pg. e35470 (Oct 13 2023) ISSN: 1536-5964 [Electronic] United States
• PMID: 37832087 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

Chemical References

• Immunoglobulin G
• Steroids
• Autoantibodies
• Receptors, Phospholipase A2

Topics

• Male
• Humans
• Glomerulonephritis, Membranous
• Nephrosis, Lipoid (chemically induced, drug therapy, pathology)
• Kidney Glomerulus (pathology)
• Proteinuria (pathology)
• Immunoglobulin G
• Steroids
• Autoantibodies
• Receptors, Phospholipase A2