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IN PRESS
Minimal Change Disease After Elective Surgical Abortion: A Case Report

Sheldon Greenberg, Kundan R. Jana, Kalyana C. Janga, Kamlesh Kumar

USA Division of Nephrology, Maimonides Medical Center, Brooklyn, NY, USA

Am J Case Rep 2021; 22:e930292 :: DOI: 10.12659/AJCR.930292

Available online: 2021-02-18, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication.
The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

#930292

BACKGROUND Pregnancy causes a physiological increase in renal blood flow and glomerular filtration rate, which leads to a transient increase in urinary protein excretion. Up to 300 mg/d proteinuria is known to occur in pregnancy due to physiological changes. Proteinuria of greater than 3 g/d is categorized as being within the nephrotic range, and the most common cause of nephrotic range proteinuria in the later stages of pregnancy is preeclampsia. Minimal change disease (MCD) as a cause of nephrotic syndrome is rare in pregnancy and is rarer still after abortion. Here, we report a patient who presented with nephrotic syndrome due to MCD after elective surgical abortion.
CASE REPORT A 21-year-old woman presented with shortness of breath, worsening anasarca, abdominal distension, and weight gain 3 weeks after undergoing elective surgical abortion at 7 weeks of gestation. There was no hematuria and no past medical history or family history of kidney disease. Investigations revealed normal serum creatinine with hypoalbuminemia, dyslipidemia, nephrotic range proteinuria, and negative serology for autoimmune diseases. Renal biopsy showed podocyte effacement with normal glomeruli and intact tubulointerstitium, confirming the diagnosis of MCD. The patient was treated with steroids, antidiuretics, statins, and angiotensin receptor blockers. She responded well, showing symptomatic improvement and resolution of proteinuria, hypoalbuminemia, and dyslipidemia. She was gradually tapered off steroids during subsequent follow-up visits.
CONCLUSIONS Only a single case of a patient presenting with acute renal failure and MCD after a missed abortion has been reported. To the best of our knowledge, this is the second case report of MCD after abortion and the first report of a patient with MCD without acute renal failure after elective termination of pregnancy.

Keywords: Abortion, Induced; Nephrosis, Lipoid; Nephrotic Syndrome

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