Conversion of Minimal Change Disease to Focal Segmental Glomerlosclerosis in a Patient with Hodgkins Lymphoma
Journal of Investigative Medicine
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Case report The patient is an eleven years old female who initially presented with generalised swelling of the body involving her face, abdomen and extremities. She was diagnosed with nephrotic syndrome given her exam findings of elevated protein to creatinine ratio (3.2), hypoalbuminemia (2.5 g/dL) and hyperlipidemia (cholesterol 262 mg/dL). Her initial renal biopsy was suggestive of minimal change disease (MCD). Patient continued to have significant proteinuria and generalised oedema and exhibited no response to mycophenolate, cyclosporine, or steroids. Therefore, a second renal biopsy was done which indicated focal segmental glomerulosclerosis (FSGS), (figure 1). She received three doses of rituximab and had marked reduction of oedema and proteinuria. Eventually she had normalisation of renal function after several months. However, the patient started complaining of chest pain and dyspnea. Computed Tomography (CT) imaging showed diffuse lymphadenopathy. Lymph node biopsy was compatible with a diagnosis of Hodgkin’s Lymphoma (HL). Our patient had a dramatic response to rituximab, which treated not only her Hodgkin’s Lymphoma but also the associated paraneoplastic steroid resistant nephrotic syndrome. Solid organ tumours and haematological malignancies can present as glomerular disease. HL is well known to be associated with minimal change disease (MCD) often resolving with adequate treatment of the HL. Focal segmental glomerulosclerosis (FSGS) is one of the frequently reported associations with malignancy. There have been anecdotal reports of FSGS associated with mantle cell lymphoma and Hodgkin’s lymphoma. To our knowledge there has been no report of MCD transition to FSGS in a patient with Hodgkin’s lymphoma.
Diagnosis | Medicine and Health Sciences
Conversion of Minimal Change Disease to Focal Segmental Glomerlosclerosis in a Patient with Hodgkins Lymphoma.
Journal of Investigative Medicine, 66(1),