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Diagnosis: Podocytopathy: Minimal Change Disease

Clinical presentations of older patients with minimal change disease (MCD) were similar to younger patients apart from the age‐related decline of renal function and higher prevalence of hypertension. Both groups have similar steroid responsiveness, but older patients tend to have fewer relapses and require fewer second agents for treatment of relapses. (Tse KC, et al. Idiopathic minimal change nephrotic syndrome in older adults: steroid responsiveness and pattern of relapses. Nephrol Dial Transplant. 2003;18:1316-1320. [PubMed link]; Nolasco F, et al. Adult-onset minimal change nephrotic syndrome: a long-term follow-up. Kidney Int. 1986;29:1215-1223. [PubMed link]).

The current understanding on MCD is mainly based on data derived from children and very few adults. The pathogenic mechanisms of MCD are currently unclear. Some studies have indicated that T lymphocytes, particularly T helper (Th) cells, affect the onset of MCD. After Th cells differentiate into Th2 cells, the ones expressing high levels of IL‐4 and IL‐13 can participate in the onset of MCD. Importantly, patients with MCD have low serum IgG levels and elevated IgE levels, suggesting that humoural immunity is involved in the onset of MCD. The onset of MCD is related to circulating immune factors and proteinuria induced by podocyte dysfunction and podocyte injury; however, other mechanisms may also be involved in the pathogenesis of MCD, and the pathogenic factors involved in these mechanisms have not yet been identified. A single theory cannot fully explain the pathophysiological course of MCD, and more details on the mechanisms involved in this process are needed (Han H, et al. Increased number and activation of peripheral basophils in adult-onset minimal change disease. J Cell Mol Med. 2020;24(14):7841-7849. [PubMed link]). In our patient, we were unable to determine a specific etiology, however, we suspected that it could be related to some medication.

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