Tang L, Cai Z, Wang SX, Zhao WJ. Transition from minimal change disease to focal segmental glomerulosclerosis related to occupational exposure: A case report. World J Clin Cases 2022; 10(17): 5861-5868 [PMID: 35979127 DOI: 10.12998/wjcc.v10.i17.5861]
Corresponding Author of This Article
Wen-Jing Zhao, MD, PhD, Associate Professor, Chief Physician, Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China. wenjingz@263.net
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jun 16, 2022; 10(17): 5861-5868 Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5861
Transition from minimal change disease to focal segmental glomerulosclerosis related to occupational exposure: A case report
Long Tang, Zhen Cai, Su-Xia Wang, Wen-Jing Zhao
Long Tang, Zhen Cai, Wen-Jing Zhao, Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
Su-Xia Wang, Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Peking University Institute of Nephrology, Beijing 100034, China
Author contributions: Tang L obtained and interpreted the patient clinical data, wrote and finally submitted the manuscript; Tang L and Cai Z performed the histological examination of the kidney, participated in the analysis of patient pathological data; Zhao WJ and Wang SX critically reviewed and revised the final manuscript, and were consultants during the treatment and the final diagnosis; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Jing Zhao, MD, PhD, Associate Professor, Chief Physician, Department of Nephrology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, No. 23 Meishuguanhou Street, Dongcheng District, Beijing 100010, China. wenjingz@263.net
Received: December 29, 2021 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
Abstract
BACKGROUND
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.
CASE SUMMARY
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.
CONCLUSION
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.
