Beyond Preeclampsia: Steroid-Refractory Minimal Change Disease Presenting as Hypertension and Proteinuria in Pregnancy

We present a case of a 35-year-old pregnant woman (second pregnancy, 0 term or preterm births, 1 abortion/miscarriage, and 0 living children) with new-onset hypertension, lower extremity edema, and proteinuria in the third trimester who was initially diagnosed with preeclampsia. After delivery, her edema and proteinuria continued to increase, prompting consideration of alternative diagnoses. Her evaluation included a kidney biopsy that revealed minimal change disease/focal segmental glomerulosclerosis. Treatment with prednisone resulted in a rapid, but only partial, response. She was later treated with tacrolimus, with steady improvement. This case highlights the importance of looking beyond preeclampsia when a pregnant or postpartum patient has persistent hypertension and nephrotic-range proteinuria.