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Minimal-change nephrotic syndrome in a hematopoietic stem-cell transplant recipient

Benjamin D Humphreys, Vijay K Vanguri, Joel Henderson, Joseph H Antin
Nature Clinical Practice. Nephrology 2006, 2 (9): 535-9; quiz 540

BACKGROUND: A 61-year-old woman received standard immunizations, including Haemophilus influenzae type B, diphtheria, tetanus toxoid, and unconjugated 23-valent pneumococcal vaccine (Pneumovax), Merck & Co., Inc., Whitehouse Station, NJ), 1 year after undergoing nonmyeloablative hematopoietic stem-cell transplantation for acute myelogenous leukemia. After 5 days, she developed fatigue with progressive weight gain and edema, and 14 days after immunization she presented with anasarca and was found to have acute renal failure and nephrotic proteinuria.

INVESTIGATIONS: Physical examination, serum chemistry, examination of urine sediment, renal ultrasound using Doppler scanning, 24 h urine collection, and renal biopsy.

DIAGNOSIS: Minimal-change nephrotic syndrome with acute tubular injury.

MANAGEMENT: Aggressive diuresis and oral corticosteroid therapy.

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