Case Reports in Nephrology最新文献

{"title":"Dual Aetiology of Diabetes Insipidus in Pregnancy: Vasopressinase-Mediated and Central Mechanisms.","authors":"Philani Ezekiel Mkhize, Pauli van Heerden, Tholakele Sabela, Mogamat Razeen Davids, Mogamat-Yazied Chothia","doi":"10.1155/crin/7536497","DOIUrl":"10.1155/crin/7536497","url":null,"abstract":"<p><p>Diabetes insipidus (DI) is a heterogeneous disorder characterised by polyuria and polydipsia due to impaired arginine vasopressin (AVP) secretion or action. We describe a 36-year-old pregnant woman who presented at 28 weeks' gestation with weakness, severe hypokalaemia from renal potassium wasting, hypernatraemia and polyuria with dilute urine. Vasopressinase-mediated DI was suspected; there was no response to AVP, but desmopressin (dDAVP) produced a rapid clinical improvement, confirming the diagnosis. However, postpartum recurrence of symptoms prompted further evaluation, with imaging suggestive of lymphocytic infundibuloneurohypophysitis, necessitating reinitiation of dDAVP. This case highlights the diagnostic complexity of DI in pregnancy and the need to remain vigilant for central causes, even when vasopressinase-mediated DI is initially suspected.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"7536497"},"PeriodicalIF":0.0,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13280982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel NPHS1-Associated Phenotype Characterized by Recurrent Transient Proteinuria.","authors":"Etsuko Tanaka, Takao Konomoto, Hiromi Sakaguchi, Jun Kurogi, Nana Sakakibara, Kandai Nozu, Hiroshi Moritake","doi":"10.1155/crin/4258555","DOIUrl":"10.1155/crin/4258555","url":null,"abstract":"<p><p>We herein report the case of a 2-year-old girl with novel compound heterozygous <i>NPHS1</i> variants, p.R460Q (a known loss-of-function mutation) and p.V822M (a rare variant with reported pathogenicity and relatively mild functional effects). She initially presented with typical features of idiopathic nephrotic syndrome and achieved complete remission on Day 10 of corticosteroid therapy. After tapering, the patient developed recurrent episodes of infection-associated heavy proteinuria, which often remitted spontaneously but sometimes left residual low-grade proteinuria. Despite the introduction of cyclosporine, these episodes continued, and the effect of immunosuppression remained unclear. Over a 4-year follow-up, recurrent transient proteinuria persisted, but no relapse of nephrotic syndrome or renal dysfunction was observed. This atypical clinical pattern, characterized by incomplete remissions and limited response to immunosuppressive therapy, prompted genetic testing, which revealed compound heterozygous <i>NPHS1</i> variants. This case expands the phenotypic spectrum of <i>NPHS1</i>-associated disease, thus highlighting that nephrin variants may manifest as steroid responsiveness, preserved renal function, and repeated transient proteinuria. Our findings emphasize the role of genetic testing in clarifying diagnosis and guiding management in steroid-sensitive nephrotic syndrome with atypical features.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"4258555"},"PeriodicalIF":0.0,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Renal Artery Thrombosis With Distal Abdominal Aortic Dissection as the First Presentation of Takayasu Arteritis.","authors":"Mihiran Thanigasalan, Mehatheepan Rasanayagam, Mathu Selvarajah","doi":"10.1155/crin/2515985","DOIUrl":"10.1155/crin/2515985","url":null,"abstract":"<p><strong>Background: </strong>Takayasu arteritis (TAK) is a chronic granulomatous large-vessel vasculitis that predominantly affects the aorta and its major branches, leading to stenosis, occlusion, or aneurysmal changes. Renal artery disease is common, but acute bilateral renal artery thrombosis causing renal dysfunction is rare.</p><p><strong>Case presentation: </strong>A 38-year-old South Asian male presented with a two-week history of abrupt-onset bilateral loin pain and severe azotemia (creatinine 8.25 mg/dL). Inflammatory markers were high (ESR 102 mm/h; CRP 45 mg/L). Ultrasound showed preserved renal size; Doppler suggested globally poor bilateral renal perfusion. CT angiography revealed bilateral renal artery thrombosis, mural thickening of the renal arteries, and a distal abdominal aortic dissection extending to the iliac arteries. Infectious, autoimmune, and limited thrombophilia screens were negative. The clinical and radiological constellation was most consistent with TAK, based on imaging evidence of large-vessel vasculitis involving bilateral renal arteries and compatible clinical findings. A multidisciplinary team (nephrology, vascular surgery, and rheumatology) advised anticoagulation due to bilateral renal artery thrombosis despite the distal Type B dissection. He received intravenous methylprednisolone followed by oral prednisolone, with recovery of renal function to 1.8 mg/dL and normalization of inflammatory markers in a month.</p><p><strong>Conclusions: </strong>In young adults presenting with abrupt bilateral renal ischemia and systemic inflammation, TAK should be considered. Early vascular imaging and prompt immunosuppression can preserve renal function. Anticoagulation therapy may be justified in selected cases of thrombosis even in the presence of limited dissection, provided decisions are multidisciplinary and blood pressure is tightly controlled.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"2515985"},"PeriodicalIF":0.0,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gitelman Syndrome in a Child Presenting With Polyuria and Polydipsia: Diagnostic Challenges in a Resource-Limited Setting.","authors":"Erneus Ernest, Devis Simbila","doi":"10.1155/crin/8879176","DOIUrl":"10.1155/crin/8879176","url":null,"abstract":"<p><p>Gitelman syndrome (GS) is a rare inherited renal salt-wasting tubulopathy characterized by hypokalemia, hypomagnesemia, and hypocalciuria. Its nonspecific presentation often overlaps with that of more common pediatric conditions, leading to delayed diagnosis, particularly in resource-limited settings. We report an 11-year-old boy who presented with progressive weight loss, polyuria, polydipsia, and salt craving. His course was complicated by recurrent episodes of severe hypokalemia and hypomagnesemia, and he was initially evaluated for diabetes mellitus, other endocrine disorders, chronic infections such as tuberculosis, and malnutrition without a definitive diagnosis. During the index admission, he developed acute worsening of muscle weakness associated with severe hypokalemia and hypomagnesemia and biochemical findings consistent with renal salt wasting, supporting a diagnosis of GS in the absence of genetic testing. Management with correction of hypovolemia, electrolyte supplementation, liberal salt intake, and nutritional support led to marked clinical improvement and stabilization of biochemical abnormalities on follow-up. This case highlights the importance of maintaining a high index of suspicion for GS in children presenting with polyuria, polydipsia, salt craving, and unexplained electrolyte disturbances, particularly in resource-limited settings.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"8879176"},"PeriodicalIF":0.0,"publicationDate":"2026-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13239079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mercury in Retrograde: The Tale of Toxicity.","authors":"Sandra Abadir, Rafi Orphali, Garo Kalfayan, Arian Gower, Mercury Lin, Jasprit Takher","doi":"10.1155/crin/1913507","DOIUrl":"10.1155/crin/1913507","url":null,"abstract":"<p><strong>Introduction: </strong>Mercuric chloride is a highly toxic inorganic compound with historical medical use but severe potential for harm when ingested. Acute mercury poisoning is rare but can lead to multiorgan toxicity, particularly affecting the kidneys and gastrointestinal tract. Prompt recognition and intervention are essential to prevent long-term sequelae and mortality.</p><p><strong>Case presentation: </strong>An 18-year-old male with a psychiatric history presented one hour after intentional ingestion of five mercuric chloride tablets. He exhibited mild abdominal symptoms, and initial laboratory studies revealed proteinuria, glycosuria, and rising creatinine. Imaging showed echogenic kidneys, and serum mercury levels were markedly elevated at 840 μg/L. He was treated with oral dimercaptosuccinic acid (DMSA), intravenous fluids, and gastrointestinal decontamination. Despite therapy, his renal function declined, with creatinine peaking at 9.6 mg/dL, requiring hemodialysis. Renal biopsy demonstrated acute tubular necrosis without immune complex deposition. After six sessions of hemodialysis and 16 days of chelation therapy, renal function and mercury levels improved, allowing discharge to psychiatric care.</p><p><strong>Discussion: </strong>Mercuric chloride exerts its nephrotoxic effects primarily through oxidative injury to proximal tubular cells, resulting in acute tubular necrosis. While chronic mercury exposure is more often associated with glomerular diseases, acute ingestion more typically causes tubular injury. Chelation with DMSA facilitates mercury elimination but may be insufficient when renal impairment occurs. In such cases, hemodialysis becomes essential for toxin clearance and metabolic support. This case underscores the importance of early, combined therapeutic interventions.</p><p><strong>Conclusion: </strong>Acute mercuric chloride ingestion is a medical emergency that can cause life-threatening renal toxicity. Timely initiation of chelation therapy and supportive measures, including hemodialysis, are crucial for recovery. This case demonstrates that even in severe presentations, multidisciplinary management can result in favorable outcomes.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"1913507"},"PeriodicalIF":0.0,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13216714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapidly Progressive IgA Nephropathy in a Patient With a History of Breast Cancer: A Case Report and Literature Review.","authors":"Roger Leon Montesinos, Edwin Quispe Marca, Carla Arnez Torrico, Daniel Segura Herbas, Luis Céspedes Limachi, Zulma Tapia Arenas, Wilder Villca Mamani","doi":"10.1155/crin/5546873","DOIUrl":"10.1155/crin/5546873","url":null,"abstract":"<p><p>IgA nephropathy (IgAN), or Berger's disease, is the most common primary glomerulopathy worldwide. It is characterized by dominant mesangial deposition of immunoglobulin A1 (IgA1), typically of the galactose-deficient form (Gd-IgA1), which triggers the formation of circulating immune complexes and subsequent glomerular inflammation. Clinical presentation includes hematuria, proteinuria, and, in severe cases, progressive renal failure. A rare variant is the extracapillary or crescentic form, which follows an aggressive course. We report the case of a 52-year-old woman with a history of Stage II right-sided infiltrating ductal breast carcinoma, treated in 2023 with radical mastectomy, AC-T chemotherapy, and radiotherapy. Complete oncologic remission was confirmed by SPECT imaging. In January 2025, with a known baseline creatinine of 1.2 mg/dL, the patient presented with macroscopic hematuria, hypertension, and rapid decline in renal function. Workup revealed subnephrotic proteinuria (1854 mg/24 h), active urinary sediment with 65% dysmorphic erythrocytes and red blood cell casts, and a creatinine peak of 4.7 mg/dL. Autoimmune serologies were negative. Kidney biopsy showed IgAN with cellular crescents in 64% of glomeruli and an Oxford classification of M0 E0 S1T1 C2. Immunofluorescence confirmed mesangial IgA and C3 deposits. Despite treatment with intravenous methylprednisolone, cyclophosphamide, and oral prednisone, yet no renal recovery was achieved, and the patient remains on chronic hemodialysis. To our knowledge, this is the first reported case in Bolivia of extracapillary IgAN occurring after breast cancer remission, highlighting a rare clinical association and raising the possibility of an underlying immune-mediated link between malignancy and crescentic IgAN, without establishing causality.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"5546873"},"PeriodicalIF":0.0,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13201900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel CRB2 Mutation Associated With FSGS and ESRD in an Adult Patient.","authors":"Michele Marchini, Sonila Mocka, Matteo Trezzi","doi":"10.1155/crin/8140153","DOIUrl":"10.1155/crin/8140153","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a major global health concern, with a substantial proportion of cases that remain of undetermined cause. Mutations in genes affecting podocyte structure and function, are increasingly recognized as causes of focal segmental glomerulosclerosis (FSGS), a common but highly nonspecific histological pattern of kidney injury, that ultimately lead to CKD.</p><p><strong>Case presentation: </strong>We report the case of a 55-year-old male who presented with hypertension and end-stage renal disease (ESRD) of unknown etiology. He had a progressive decline in kidney function and proteinuria beginning in young adulthood. A kidney biopsy showed a pattern of FSGS. A comprehensive workup did not identify autoimmune or inflammatory causes. Whole-exome sequencing detected a previously undescribed heterozygous CRB2 mutation (c.1037G > T, p.Cys346Phe), predicted to be deleterious.</p><p><strong>Discussion: </strong>Animal models of CRB2 deprivation in podocytes showed progression toward FSGS. In humans, CRB2 mutations have previously been linked to severe early-onset nephrotic syndrome, typically in homozygous or compound heterozygous states. This is the first report of an adult-onset CRB2-associated FSGS in a heterozygous state, suggesting a milder disease course with a progressive kidney decline. As with other genetic forms of FSGS, we hypothesize that heterozygous CRB2 mutations may permit near-normal renal function for years until cumulative stressors trigger podocyte injury and CKD progression.</p><p><strong>Conclusion: </strong>This case expands the clinical spectrum of CRB2-related kidney disease and highlights the importance of genetic testing in adults with unexplained CKD. Identifying genetic forms of CKD may refine diagnostic and therapeutic approaches in nephrology.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"8140153"},"PeriodicalIF":0.0,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13189462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rifampin: The Cause of Acute Tubular Injury-A Case Report.","authors":"Muhammad Umer Arif, Areeba Farooq, Harjinder Singh, Muhammad Talha Javaid, Mudassar Hussain","doi":"10.1155/crin/7336365","DOIUrl":"10.1155/crin/7336365","url":null,"abstract":"<p><p>Tuberculosis (TB) presents with fever, night sweats, and cough. The antituberculous therapy (ATT) used to treat TB affects various systems, including the renal system and the hepatobiliary system. ATT-induced acute tubular necrosis (ATN) can have various presentations, such as fever, vomiting, diarrhea, abdominal pain, oliguria, and cola-colored urine. We present a case of a 56-year-old patient using ATT. He presented with the complaint of altered mental status, vomiting, jaundice, and cola-colored urine. Labs revealed elevated liver enzymes, elevated creatinine, anemia, and thrombocytopenia. The autoimmune profile was normal; however, the biopsy revealed ATN. In addition to supportive management, hemodialysis and steroid therapy were initiated. Discontinuation of rifampin along with continuation of modified ATT therapy led to improved renal function tests, platelet counts, and Hb levels.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"7336365"},"PeriodicalIF":0.0,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13125855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indirect Disaster-Related Deaths Among Hemodialysis Patients Following the Fukushima Daiichi Nuclear Power Plant Accident.","authors":"Ryoma Yoshida, Toyoaki Sawano, Yuna Uchi, Moe Kawashima, Kemmei Kitazawa, Hidenori Marui, Hiroki Yoshimura, Saori Nonaka, Naomi Ito, Chika Yamamoto, Toshiki Abe, Michio Murakami, Momoka Yamamura, Tianchen Zhao, Mamoru Sakakibara, Kazuko Yagiuchi, Mako Otsuki, Akihiko Ozaki, Tomoyoshi Oikawa, Shinichi Niwa, Masaharu Tsubokura","doi":"10.1155/crin/8847100","DOIUrl":"10.1155/crin/8847100","url":null,"abstract":"<p><strong>Introduction: </strong>Disaster-related deaths (DRDs) are indirect fatalities caused by physical or psychological stress during evacuation. Patients undergoing hemodialysis (HD) face increased vulnerability during disasters due to reduced dialysis frequency, elevated mental stress, and limited access to medical resources. Although their risk is heightened, detailed analyses of DRDs in HD patients remain sparse.</p><p><strong>Methods: </strong>This retrospective study analyzed 13 HD-related DRD cases in Minamisoma City, Fukushima Prefecture, following the Fukushima Daiichi Nuclear Power Plant accident. A total of 520 DRDs were certified in the city. Data from local government records were extracted, focusing on time of death, causes of death, and psychiatric symptoms.</p><p><strong>Results: </strong>The mean age (± standard deviation) at death for HD patients was 77.92 (±8.37) years, which was younger than the mean age (± standard deviation) of 82.81 (±11.97) years among non-HD individuals (Welch's <i>t</i>-test, <i>p</i> = 0.060). Most deaths occurred during the chronic phase of the disaster. Primary causes included exacerbation of chronic kidney disease, cardiovascular complications, and sepsis. Over half of the patients exhibited psychiatric symptoms such as depression or mood instability.</p><p><strong>Discussion: </strong>This case series illustrates the severe impact of disruptions in medical care and the stress of repeated evacuations. Challenges include insufficient continuity of care and prolonged psychological distress, particularly during the chronic disaster phase. Our findings suggest that ensuring uninterrupted HD and providing long-term psychological support may be essential to mitigating DRDs in this population.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"8847100"},"PeriodicalIF":0.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Remission of Late Relapsing Membranous Nephropathy After Previous Immunosuppressant-Induced Remission: Case Report.","authors":"Yangming Cao","doi":"10.1155/crin/6703642","DOIUrl":"10.1155/crin/6703642","url":null,"abstract":"<p><p>This is the first detailed report of spontaneous remission of late relapsing membranous nephropathy (MN) after previous immunosuppressant-induced remission. In March 2004, a 52-year-old Hispanic male presented with severe nephrotic syndrome with proteinuria of 13 g/24 h. The workup for infectious and autoimmune diseases was unrevealing. Renal biopsy showed MN (Stage II). A CT scan showed no malignancy but left pulmonary embolism and left renal vein thrombosis. Anticoagulation was started for asymptomatic thromboembolism. He achieved sustained complete remission of nephrotic syndrome after a prolonged, complicated treatment course of multiple immunosuppressants (corticosteroids and mycophenolate mofetil for 1 year, followed by alternating monthly corticosteroids and chlorambucil for 6 months, and again corticosteroids and mycophenolate mofetil for 6 years). Then in July 2021 (now at the age of 69 years), he developed nephrotic syndrome again with proteinuria of 6 g/24 h. Serological work-up was all negative except for the elevated serum Antiphospholipase A2 receptor (PLA2R) antibody at 42 RU/mL (nl < 14). Renal biopsy in November 2021 showed again MN (Stage III to IV). Immunohistochemistry staining of the biopsy tissue for PLA2R1 antigen was positive. A decision was made to observe him instead of starting immunosuppressants. He was treated with diuretics and Lisinopril. Anti-PLA2R antibody steadily improved to normal range and the nephrotic syndrome gradually improved and finally resolved by August 2023. There was no recurrence of nephrotic syndrome up to the most recent visit in March 2026. A review of the literature shows that a repeat biopsy in patients already known to have MN (especially those PLA2R-mediated cases) with relapse of nephrosis and stable renal function may not be necessary. In routine practice, the watchful waiting strategy for relapse of MN is less often taken as it should be. Therefore, more patients with relapsing MN deserve an observation period before starting immunosuppressants. Hopefully, KDIGO guidelines can include this point for relapsing MN.</p>","PeriodicalId":9604,"journal":{"name":"Case Reports in Nephrology","volume":"2026 ","pages":"6703642"},"PeriodicalIF":0.0,"publicationDate":"2026-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}