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Secondary minimal change disease — ESENeph MCQ

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ModerateGlomerulonephritisSecondary minimal change diseaseESENeph

A 29-year-old woman has nephrotic syndrome 6 months after treatment for Hodgkin lymphoma. Creatinine is 68 micromol/L, albumin 17 g/L and urine PCR 980 mg/mmol. Renal biopsy shows normal glomeruli on light microscopy with diffuse foot process effacement and no immune deposits. What is the most likely diagnosis?

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Correct answer: B — Secondary minimal change disease

Minimal change disease is associated with Hodgkin lymphoma and can present with abrupt nephrotic syndrome and diffuse foot process effacement. Primary membranous nephropathy would show immune deposits along capillary walls and often anti-PLA2R positivity. Amyloid nephropathy causes Congo red-positive deposits and a more chronic course. The pearl is that adult nephrotic syndrome should prompt evaluation for secondary drivers including drugs, malignancy and infection.

Reference: KDIGO 2021 Glomerular Diseases Guideline