Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5861
Peer-review started: December 29, 2021
First decision: February 8, 2022
Revised: February 21, 2022
Accepted: April 22, 2022
Article in press: April 22, 2022
Published online: June 16, 2022
Processing time: 162 Days and 3.1 Hours
Although minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) have been described as two separate forms of nephrotic syndrome (NS), they are not completely independent. We report a case of a patient transitioning from MCD to FSGS, review the literature, and explore the relationship between the two diseases.
A 42-year-old male welder, presenting with lower extremity edema and elevated serum creatinine, was diagnosed with NS and end-stage kidney disease (ESKD) based on laboratory test results. The patient had undergone a kidney biopsy for NS 20 years previously, which indicated MCD, and a second recent kidney biopsy suggested FSGS. The patient was an electric welder with excessive levels of cadmium and lead in his blood. Consequently, we suspect that his aggravated pathology and occurrence of ESKD were related to metal nephrotoxicity. The patient eventually received kidney replacement therapy and quit his job which involved long-term exposure to metals. During the 1-year follow-up period, the patient was negative for metal elements in the blood and urine and recovered partial kidney function.
MCD and FSGS may be different stages of the same disease. The transition from MCD to FSGS in this case indicates disease progression, which may be related to excessive metal contaminants caused by the patient’s occupation.
Core Tip: Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are the two major forms of nephrotic syndrome. Although MCD and FSGS are defined as different types of primary glomerular disease, there is some overlap between them in clinical features and pathological changes. We present a rare case that highlights that MCD and FSGS are actually different histological manifestations of the same disease progression. FSGS may be MCD of advanced stage, and metal overexposure may be an important cause of disease progression.