Successful Treatment of Nephrotic Syndrome Due to Collapsing Focal Segmental Glomerulosclerosis Accompanied by Acute Interstitial Nephritis

Hisato Shima; Toshio Doi; Takuya Okamoto; Yusuke Higashiguchi; Megumi Harada; Tomoko Inoue; Manabu Tashiro; Seiichiro Wariishi; Norimichi Takamatsu; Kazuhiko Kawahara; Kazuyoshi Okada; Jun Minakuchi

doi:10.2169/internalmedicine.8258-21

CASE REPORTS

Successful Treatment of Nephrotic Syndrome Due to Collapsing Focal Segmental Glomerulosclerosis Accompanied by Acute Interstitial Nephritis

Hisato Shima, Toshio Doi, Takuya Okamoto, Yusuke Higashiguchi, Megumi Harada, Tomoko Inoue, Manabu Tashiro, Seiichiro Wariishi, Norimichi Takamatsu, Kazuhiko Kawahara, Kazuyoshi Okada, Jun Minakuchi

Author information

Hisato Shima
Department of Kidney Disease, Kawashima Hospital, Japan
Toshio Doi
Department of Kidney Disease, Kawashima Hospital, Japan
Takuya Okamoto
Department of Laboratory, Kawashima Hospital, Japan
Yusuke Higashiguchi
Department of Clinical Engineering Kawashima Hospital, Japan
Megumi Harada
Department of Clinical Engineering Kawashima Hospital, Japan
Tomoko Inoue
Department of Kidney Disease, Kawashima Hospital, Japan
Manabu Tashiro
Department of Kidney Disease, Kawashima Hospital, Japan
Seiichiro Wariishi
Department of Cardiovascular Surgery, Kawashima Hospital, Japan
Norimichi Takamatsu
Department of Laboratory, Kawashima Hospital, Japan
Kazuhiko Kawahara
Department of Kidney Disease, Kawashima Hospital, Japan
Kazuyoshi Okada
Department of Kidney Disease, Kawashima Hospital, Japan
Jun Minakuchi
Department of Kidney Disease, Kawashima Hospital, Japan

Keywords: nephrotic syndrome, collapsing focal segmental glomerulosclerosis, steroid, cyclosporin, low-density lipoprotein apheresis

JOURNAL OPEN ACCESS

2022 Volume 61 Issue 12 Pages 1863-1867

DOI https://doi.org/10.2169/internalmedicine.8258-21

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Details

Abstract

A 39-year-old woman was hospitalized for nephrotic syndrome. Laboratory test results showed increased serum creatinine levels and urinary excretions of beta-2-microglobulin, and N-acetyl-beta-D-glucosaminidase. A renal biopsy revealed collapsing focal segmental glomerulosclerosis (FSGS) and acute interstitial nephritis. Despite treatment with pulse steroid followed by oral high-dose glucocorticoids and cyclosporines, heavy proteinuria persisted. After low-density lipoprotein apheresis (LDL-A) therapy was initiated, her proteinuria gradually decreased, leading to complete remission. A repeat renal biopsy after treatment revealed no collapsing glomeruli. Immediate LDL-A should be performed to treat cases of collapsing FSGS poorly responding to other treatments.

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