Minimal-change renal disease and Graves’ disease: a case report and literature review

OBJECTIVE To describe a possible association between Graves' disease and nephrotic syndrome secondary to minimal change renal disease and to review the literature related to renal diseases in patients with Graves' disease. METHODS The clinical, laboratory, and renal biopsy findings in a patient with Graves' disease and minimal change renal disease are discussed. In addition, the pertinent English-language literature published from 1966 to 2009, determined by means of a MEDLINE search, is reviewed. RESULTS A 63-year-old man who was admitted to the hospital with nephrotic syndrome. Patient had a history of Graves' disease for last 2 years with associated ophthalmopathy. He had been treated with methimazole and low low-dose steroids (prednisone 5 mg daily). Examination revealed generalized oedemaedema and exophthalmoses. Laboratory tests showed 6.62 g/day of proteinuria. Antinuclear antibodies, anti-glomerular basement membrane antibodies, antineutrophil cytoplasmic antibody (ANCA), serum complement levels, cryoglobulin, hepatitis screen and serum and urine protein electrophoreses were normal. A kidney biopsy revealed features consistent with minimal change disease on light, immunofluorescence, and electron microscopy. The patient had an excellent clinical and laboratory response after treatment with steroids and near total thyroidectomy. CONCLUSIONS To the best of our knowledge, this is the fourth report of the occurrence of minimal change disease in a patient with Graves' disease in the absence of any other immunologic disorder known to be associated with minimal change renal disease.