ABSTRACT
Introduction: Minimal change disease is a histopathological lesion of the kidneys most commonly associated with nephrotic syndrome. Three pathophysiological mechanisms have been proposed to explain this syndrome: Nephrosarca (severe edema of the kidney), presence of acute tubular necrosis and decreased of glomerular filtration rate. Presentation of Case: We present a 69years old patient with minimal change disease presented with severe renal dysfunction, dyspnoea, oedema of the lower extremities and weight gain of 10kg the month prior to admission. Renal function did not improve despite excess fluid removal with hemodialysis. Renal biopsy did not show significant interstitial Oedema but showed signs of tubular damage and mild atherosclerosis. Renal function returned with remission of proteinuria following administration of corticosteroid therapy. Conclusion: Our case does not support the nephrosarca hypothesis but the presence of acute tubular necrosis and decreased of glomerular filtration rate theories cannot be excluded.