Heavy proteinuria of 25.4 g per 24 hours in a 52-year-old patient from Ethiopia with steroid-responsive minimal change disease: a case report

Abstract

INTRODUCTION: Nephrotic syndrome refers to a distinct constellation of clinical and laboratory features of renal disease. The majority of cases of glomerular proteinuria range from 1 to 15 g of protein per 24 hours of urine. Heavy proteinuria of 25.4 g with steroid-responsive nephrotic syndrome is a rare clinical presentation of glomerulopathy. This patient presented with a significantly high degree of proteinuria in the context of retroviral infection with steroid-responsive nephrotic syndrome, which is a rare clinical scenario. CASE PRESENTATION: A 52-year-old male patient from Ethiopia with human immunodeficiency virus for the past 13 years on antiretroviral therapy with undetectable viral load presented with a 2-year history of intermittent generalized body swelling. Physical examination showed periorbital and facial puffiness, gross ascites, and bilateral lower extremity edema. A 24-hour urine protein determination showed proteinuria of 25.4 g, significant hypoalbuminemia, and hypercholesterolemia, and renal biopsy result was in favor of minimal change disease. CONCLUSION: Heavy proteinuria of 25.4 g per 24 hours is a rare presenting feature of adult primary nephrotic syndrome, specifically minimal change disease.