Nephrotic syndrome with Minimal Change Disease and Atopy in NorthAfrican adults

Abstract

Background: In adults, minimal change disease (MCD) accounts for 15 to 25% of nephrotic syndrome (NS). Numerous reports have suggested a
link between NS and atopy. However, data on treatment and prognosis of NS associated with allergy are limited.
Aim: To examine the presenting characteristics, treatments and outcomes of adults with allergic MCD in a North African center.
Methods: This was an observational study using retrospectively collected data. Patients were recruited from the Nephrology department of Sahloul
Hospital (Sousse, Tunisia) from January 2006 to December 2020. Adults with a biopsy proved MCD, which was associated with atopy, were included.
Results: Fifteen patients (eight males, age mean±SD: 34±13 years) were included. High eosinophil and immunoglobulin E (IgE) levels were noted in
three and twelve patients respectively. The IgE mean level at the initial presentation was 1431 IU/ml. Allergic skin tests were positive in nine patients.
All patients were treated with corticosteroids, five had anti-histamine therapy and five had hyposensitization therapy, which was successful in two
patients. Thirteen patients had relapsed during follow-up. Mean eosinophil level was significantly higher in patients with frequent relapses compared
to those with infrequent relapses (5415/mm³ vs. 239.12/mm³, respectively, p=0.022). Two patients had progressed to chronic renal failure.
Conclusion: It is important to search for atopic disorders in patients with MCD to better control this disease and use specific treatments. However,
the efficacy of anti-allergic therapies has to be proven.