Spontaneous Remission of Minimal Change Disease in Pancreatic Cancer

Introduction: Minimal change disease (MCD) is the third most common cause of nephrotic syndrome in adults. It can be primary or secondary. Typically, when resulting from cancer, MCD is associated with hematological malignancies such as lymphoma or thymoma. We present a case of MCD in a patient with solid organ malignancy- pancreatic cancer that went into complete remission after starting chemotherapy. Case Description: 66 year-old female with a history of triple negative breast cancer (s/p L lumpectomy without residual disease in October 2021) and no known history of renal disease, was diagnosed with pancreatic adenocarcinoma in December of 2024. 4 weeks later, she was referred to Nephrology for an acute kidney injury (AKI) found on pre-chemotherapy labs with Cr of 2.76 mg/dL (up from baseline of 0.9 mg/dL). Pt developed rapid weight gain and worsening leg swelling. On exam, vitals were stable, but she had 3+ pitting edema in bilateral lower extremities. Urinalysis showed >/= 600 protein and UPCR was 10.028 g/g of Cr. Renal biopsy was performed and showed minimal change disease. Patient was started on FOLFIRINOX regimen for chemotherapy. Within 6 weeks of starting chemotherapy, her UPCR dropped down to 0.14 g/g and AKI resolved. She continues to be in remission without requiring any immunosuppressant for MCD. Discussion: This case is unique not only in that the MCD was associated with pancreatic cancer but also in that it had a rapid complete remission within 6 weeks of starting treatment for cancer. Per our literature review, there is only one documented report of pancreatic cancer associated MCD with chemotherapy resulting in MCD remission.Electron microscopy showing complete foot process effacement