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A case of minimal change disease in a Fabry patient

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Abstract

Fabry disease is an X-linked lysosomal storage disorder caused by mutations of the GLA gene and deficiency in α-galactosidase A activity. Glycosphingolipids accumulation causes renal injury that manifests early during childhood as tubular dysfunction and later in adulthood as proteinuria and renal insufficiency. Nephrotic syndrome as the first evidence of Fabry-related kidney damage is rare. We report the case of a teenager with known Fabry disease and normal renal function who developed acute nephrotic syndrome. He was found to have typical glycosphingolipids accumulation with no other findings suggestive of alternative causes of nephrotic syndrome on kidney biopsy. After treatment with enzyme replacement therapy and oral steroids, he went into complete remission from nephrotic syndrome, a response that is atypical for Fabry disease patients who develop heavy proteinuria as a result of longstanding disease and chronic renal injury. The nephrotic syndrome in this patient appears to have developed secondary to minimal change disease. We recommend considering immunotherapy in addition to enzyme replacement therapy in those patients with confirmed Fabry disease and acute nephrotic syndrome with clinical and microscopic findings suggestive of minimal change disease.

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Authors and Affiliations

  1. Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 4006, Cincinnati, OH, 45229, USA

    Yuri A. Zarate & Robert J. Hopkin

  2. Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Larry Patterson

  3. Department of Pathology, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Hong Yin

Authors
  1. Yuri A. Zarate
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  2. Larry Patterson
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  3. Hong Yin
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  4. Robert J. Hopkin
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Correspondence to Robert J. Hopkin.

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Zarate, Y.A., Patterson, L., Yin, H. et al. A case of minimal change disease in a Fabry patient. Pediatr Nephrol 25, 553–556 (2010). https://doi.org/10.1007/s00467-009-1353-0

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  • DOI: https://doi.org/10.1007/s00467-009-1353-0

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