ABSTRACT
Introduction: Minimal change disease (MCD) is a major cause of idiopathic nephrotic syndrome (NS) which is composed of heavy proteinuria, hypoalbuminemia, and edema. It represents 15% of idiopathic NS in adults and the proportion of cases decreases with age as other entities such as membranous nephropathy become more common. Kidney damage associated with Toxicodendron species toxicity is quite rare but there are three lesions already described: proliferative glomerulonephritis, arteritis and membranous nephropathy. Here we report a case of MCD associated to Toxicodendron toxicity. Methods: A 47 year old mexican woman with no history of chronic diseases was referred to the nephrology office. She has a positive familiar history for diabetes and hypertension and she was recently vaccinated for COVID-19. She was referred for proteinuria incidentally found during routine tests three months ago which has been persistent on urinary testing afterwards, she recalls a Toxicodendron spp (poison ivy) exposure which led to an self-limited dermatitis 5 days before the first urinary test was taken. Initial workup showed 3.54 gr/24h proteinuria, hypoalbuminemia (3.2 gr/L) and hypercholesterolemia (256 mg/dl) and a nephrotic syndrome diagnosis was made. Further testing included negative HIV, HCV and HBV serology, normal C3 and C4 levels and negative anti-PLA2R, P-ANCA, C-ANCA, antinuclear antibodies. Normal kidneys were visualized on ultrasound. A kidney biopsy was performed and reported a minimal change disease. Steroid glucocorticoids was administered with methylprednisolone for three days and she was discharged with oral glucocorticoid for maintenance. On ambulatory follow up the patient had a dramatic improvement of the proteinuria. Results: A 47 year old woman developed proteinuria a few days after ivy poison exposure with a subsequent nephrotic syndrome. Renal biopsy shows a minimal change disease and good glucocorticoid response was met. Conclusions: Our hypothesis is that ivy poison exposure is directly involved in MCD onset in this patient. No conflict of interest