Albuminuria Not Attributable to Diabetic or Hypertensive Kidney Disease: Adult-Onset Minimal Change Disease Presenting With Nephrotic Syndrome in a Woman With Prediabetes and Hypertension

A 45-year-old woman with long-standing hypertension and premature menopause presented with progressive bilateral pitting leg edema. Initial evaluation showed albuminuria, microscopic hematuria and pyuria, severe mixed dyslipidemia, and prediabetes. Despite optimization of blood pressure and cardiometabolic therapy, edema progressed to the thighs, and urinary protein excretion increased. Renal ultrasonography showed increased parenchymal echogenicity, with scarring of the lower half of the left kidney. Subsequent evaluation revealed hypoalbuminemia and nephrotic-range proteinuria of 8.64 g/day. Autoimmune and viral hepatitis screening was negative, and a right renal biopsy confirmed minimal change disease (MCD)/podocytopathy. Treatment with prednisolone 60 mg/day and diuretic therapy led to rapid clinical remission, with complete resolution of edema and reduction of 24-hour urinary protein to 190 mg/day by May 2025 and 55 mg/day by July 2025. The course was complicated by steroid-induced Cushingoid features and worsening glycemia, requiring temporary addition of glimepiride. By March 2026, the patient remained clinically well with excellent lipid and glycemic control. This case highlights the importance of early nephrology referral and kidney biopsy in adults with progressive albuminuria and edema, even when cardiometabolic comorbidities such as hypertension, prediabetes, and severe dyslipidemia coexist.