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- Title
Secondary minimal change disease in two adult patients: A link with angiogenesis.
- Authors
Rayner, David C.; Shurraw, Sabin; Johnston, Curtis; Yagasundaram, Haran; Hinz, Bradley J.; Lee, C.-H.
- Abstract
This report describes two instances of minimal change disease presenting as acute nephrotic syndrome in adults, in conditions associated with disordered angiogenesis. (i) A 74-year-old woman presented with a one-month history of edema and weight gain, and was found to have nephrotic-range proteinuria (protein/creatinine = 1048 mg/mmol) and hypoalbuminemia. Onset of nephrosis was preceded by intravitreal injection of the vascular endothelial growth factor (VEGF) inhibitor ranibizumab (Lucentis), for treatment of macular degeneration. (ii) A 41-year-old woman presented to hospital with abdominal pain and pleural effusion. Within a week of admission, she developed a thousandfold increase in proteinuria (protein/creatinine = 22000). Visceral angiosarcoma was subsequently discovered involving the bowel and gallbladder. In both cases, glomerular morphology was normal by light microscopy and the diagnosis of minimal change disease was made by exclusion. No other inciting factors were identified. These cases support a significant pathogenetic role of VEGF inhibition with minimal change disease, in the first case precipitated by a minute intraocular dose of VEGF inhibitor, and in the second by vascular sarcoma, which has previously shown to have a complex relationship with VEGF. They illustrate that adult minimal change disease is often secondary, and show that therapeutic perturbation of VEGF levels may have significant consequences on the kidney.
- Publication
Canadian Journal of Pathology, 2016, Vol 8, p45
- ISSN
1918-915X
- Publication type
Article