Minimal change disease in treatment-naïve hepatitis C virus infection: A case report and literature review

Minimal change disease (MCD) accounts for 10 - 15% of idiopathic nephrotic syndromes in adults. Chronic hepatitis C virus (HCV) infection is rarely ascribed as a cause of MCD and was previously associated with interferon-based therapy. MCD in treatment-naïve chronic HCV infection is extremely rare, with only 3 cases reported in the literature. We report on a 67-year-old woman presenting with acute nephrotic syndrome and severe acute kidney injury requiring short-term dialysis. She was initially treated empirically with glucocorticoids and underwent a kidney biopsy that revealed MCD with evidence of acute tubular necrosis and mild focal acute interstitial nephritis. An extensive work-up was only significant for the presence of anti-HCV antibody with an elevated HCV viral load of genotype 1b. Her kidney function recovered, and she was discharged on an oral prednisone course with a planned taper. 4.5 months later, her HCV infection was treated with ledipasvir and sofosbuvir, and she achieved sustained virological response. The nephrotic syndrome remained in remission 24 months after initial presentation. This is a unique case where sustained remission of both the nephrotic syndrome and the HCV infection were achieved with glucocorticoids and direct antiviral agents, respectively.