IgA Nephropathy with Minimal Change Disease Can Cause Severe Acute Kidney Injury Requiring Hemodialysis

Primary IgA nephropathy (IgAN) is the most common glomerulonephritis globally and a leading cause of end-stage kidney disease. It's characterized by mesangial IgA deposition, often triggering complement activation. Minimal change disease (MCD) is a distinct cause of nephrotic syndrome, marked by podocyte foot process effacement. The co-occurrence of IgAN with superimposed MCD is rare but increasingly recognized, typically associated with a favorable renal prognosis. However, the potential for severe complications in this combined phenotype remains a critical area for clinical understanding.

This case report details a 38-year-old man presenting with acute nephrotic syndrome. A renal biopsy was performed, revealing mesangial IgA deposition. Anti-galactose-deficient IgA1 antibody (KM55) staining confirmed co-localization with IgA deposits, supporting the diagnosis of IgAN with superimposed MCD. Electron microscopy further identified characteristic foot process effacement. Initial treatment involved high-dose prednisolone therapy. Following the development of severe acute kidney injury (AKI), concurrent treatment with cyclosporine A and steroid pulse therapy was administered to manage the renal crisis.

The patient's renal biopsy confirmed IgAN with MCD, evidenced by mesangial IgA deposition and KM55 staining co-localization. Electron microscopy definitively showed foot process effacement. Despite initial high-dose prednisolone treatment, the patient's condition deteriorated, leading to severe acute kidney injury (AKI) that necessitated temporary hemodialysis (HD). This severe complication occurred despite the generally favorable prognosis associated with IgAN with MCD. > The patient ultimately responded to concurrent cyclosporine A and steroid pulse therapy, allowing for successful discontinuation of HD and subsequent improvements in renal function and proteinuria. This demonstrates that severe AKI requiring temporary HD can occur in IgAN with MCD, but may be reversible.