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Diagnosis: Minimal Change Disease

The kidney is very susceptible to xenobiotic and environmental toxins because of its unique anatomical and physiological features. The pathogenesis of drug-induced nephropathy includes direct cytotoxic damage to kidney structures and indirect damage due to changes in renal hemodynamics, immunemediated processes, production of endogenous nephrotoxins, and nephrolithiasis. The clinical manifestations of drug-induced nephropathy vary, ranging from mild reduction in renal function that includes hematuria, proteinuria, and nephrolithiasis; to severe, progressive signs of renal toxicity, resulting in end-stage renal disease. However, drug-induced nephropathy usually presents as interstitial nephritis or acute tubular necrosis. Herb medicine rarely induces glomerulopathy, and there have been several reports of drug-induced nephrotic syndrome (NS), but it is very unusual (Yang S, et al. Two Pediatric Patients with Herbal Medicine-Induced Nephrotic Syndrome. Child Kidney Dis 2015;19(2):171-175. [Full text link]).

Our patient developed signs of NS, and it is possible that the nephrotoxic may have been a unknown components of the herbal medicines that she received. Identifying the nephrotoxic ingredients of alternative medicines such as herb medicines remains difficult because of the absence of standardization and information on their drug interactions between the active components of the herbal medicines. It is also possible that the "naturopathic" medication that the patient was taking to lose weight was not related to her nephrotic syndrome.

In our case there was steroid response, with complete remision.

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