{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T17:00:52Z","timestamp":1770224452769,"version":"3.49.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T00:00:00Z","timestamp":1620086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Minimal change disease (MCD) is the most common cause of nephrotic syndrome worldwide. For decades, the foundation of the treatment has been corticosteroids. However, relapse rate is high and up to 40% of patients develop frequent relapsing\/steroid dependent course and one third become steroid resistant. This requires treatment with repeated courses of corticosteroids, and second and third line immunomodulators increasing the incidence of drug related adverse effects. More recently, there have been reports of a very small subset of Nephrotic Syndrome (NS) patients who are initially steroid sensitive and later become secondarily steroid resistant. The disease course in this small subset is often protracted leading ultimately to end stage kidney disease requiring dialysis or kidney transplantation. Unfortunately, patients with this disease course do not do well post transplantation because 80% of them will develop disease recurrence that will ultimately lead to graft failure. Few approaches have been tried over many years to reduce the frequency of relapses, and steroid dependence and there is absolutely no therapeutic intervention for patients who develop secondary steroid resistance. Nonetheless, their therapeutic index is low, evidencing the need of a safer complementary treatment. Several hypotheses, including an oxidative stress-mediated mechanism, and immune dysregulation have been proposed to date to explain the underlying mechanism of Minimal Change Disease (MCD) but its specific etiology remains elusive. Here, we report a case of a 54-year-old man with steroid and cyclosporine resistant MCD. The patient rapidly progressed to end stage kidney disease requiring initiation of chronic dialysis. Intradialytic parenteral nutrition (IDPN), albumin infusion along with a proprietary dietary supplement, as part of the supportive therapy, led to kidney function recovery and complete remission of MCD without relapses.<\/jats:p>","DOI":"10.3389\/fped.2021.614948","type":"journal-article","created":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T04:46:32Z","timestamp":1620103592000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Case Report: Novel Dietary Supplementation Associated With Kidney Recovery and Reduction in Proteinuria in a Dialysis Dependent Patient Secondary to Steroid Resistant Minimal Change Disease"],"prefix":"10.3389","volume":"9","author":[{"given":"Rasheed A.","family":"Gbadegesin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loren P. Herrera","family":"Hernandez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick D.","family":"Brophy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,5,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"332","DOI":"10.2215\/CJN.05000516","article-title":"Minimal change disease","volume":"12","author":"Vivarelli","year":"2017","journal-title":"Clin J Am Soc Nephrol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1007\/s00467-013-2483-y","article-title":"Treatment outcome of late steroid-resistant nephrotic syndrome: a study by the Midwest Pediatric Nephrology Consortium","volume":"28","author":"Straatmann","year":"2013","journal-title":"Pediatr Nephrol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1681\/ASN.2013080852","article-title":"Initial steroid sensitivity in children with steroid-resistant nephrotic syndrome predicts post-transplant recurrence","volume":"25","author":"Ding","year":"2014","journal-title":"J Am Soc Nephrol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1773","DOI":"10.1007\/s00467-018-3994-3","article-title":"Recurrence of nephrotic syndrome following kidney transplantation is associated with initial native kidney biopsy findings","volume":"33","author":"Pelletier","year":"2018","journal-title":"Pediatr Nephrol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1038\/ki.2012.412","article-title":"Therapy of relapsing minimal-change disease in adults: a new approach?","volume":"83","author":"Glassock","year":"2013","journal-title":"Kidney Int."},{"key":"B6","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1681\/ASN.2012070734","article-title":"The treatment of minimal change disease in adults","volume":"24","author":"Radhakrishnan","year":"2013","journal-title":"J Am Soc Nephrol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1681\/ASN.2014030247","article-title":"HLA-DQA1 and PLCG2 are candidate risk loci for childhood-onset steroid-sensitive nephrotic syndrome","volume":"26","author":"Gbadegesin","year":"2015","journal-title":"J Am Soc Nephrol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.1681\/ASN.2018050465","article-title":"Leveraging ancestral heterogeneity to map shared genetic risk loci in pediatric steroid-sensitive nephrotic syndrome","volume":"30","author":"Hjorten","year":"2018","journal-title":"J Am Soc Nephrol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.1681\/ASN.2018101054","article-title":"Genetic identification of two novel loci associated with steroid-sensitive nephrotic syndrome","volume":"31","author":"Dufek","year":"2019","journal-title":"J Am Soc Nephrol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1016\/j.kint.2020.05.029","article-title":"Common risk variants in NPHS1 and TNFSF15 are associated with childhood steroid-sensitive nephrotic syndrome","volume":"98","author":"Jia","year":"2020","journal-title":"Kidney Int"},{"key":"B11","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1038\/nm.2261","article-title":"Podocyte secreted angiopoietin-like-4 mediates proteinuria in glucocorticoid-sensitive nephrotic syndrome","volume":"17","author":"Clement","year":"2011","journal-title":"Nat Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.cca.2015.05.013","article-title":"Glycocalyx injury in adults with nephrotic syndrome: association with endothelial function","volume":"447","author":"Santos Salmito","year":"2015","journal-title":"Clin Chim Acta."},{"key":"B13","doi-asserted-by":"publisher","first-page":"401","DOI":"10.3390\/jcm7110401","article-title":"Angiopoietin-2: a potential mediator of the glycocalyx injury in adult nephrotic patients","volume":"7","author":"Chaves","year":"2018","journal-title":"J Clin Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1681\/ASN.2012010017","article-title":"Loss of the endothelial glycocalyx links albuminuria and vascular dysfunction","volume":"23","author":"Salmon","year":"2012","journal-title":"J A Soc Nephrol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1691","DOI":"10.1007\/s00467-009-1214-x","article-title":"T regulatory cell function in idiopathic minimal lesion nephrotic syndrome","volume":"24","author":"Araya","year":"2009","journal-title":"Pediatr Nephrol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1038\/kisup.2012.18","article-title":"Chapter 5: minimal-change disease in adults","volume":"2","author":"Eckardt","year":"2012","journal-title":"Kidney Int Suppl."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.2215\/CJN.12331213","article-title":"Comparison of methylprednisolone plus prednisolone with prednisolone alone as initial treatment in adult-onset minimal change disease: a retrospective cohort study","volume":"9","author":"Shinzawa","year":"2014","journal-title":"Clin J Am Soc Nephrol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1093\/ndt\/gfp422","article-title":"Combined cyclosporine and prednisolone therapy in adult patients with the first relapse of minimal-change nephrotic syndrome","volume":"25","author":"Eguchi","year":"2010","journal-title":"Nephrol Dial Transplant."},{"key":"B19","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1007\/s40620-019-00602-5","article-title":"Prevention of complications from use of conventional immunosuppressants: a critical review","volume":"32","author":"Ponticelli","year":"2019","journal-title":"J Nephrol"},{"key":"B20","article-title":"Therapy in nephrology & hypertension: a companion to brenner & rector's the kidney","author":"Wilcox","year":"2008","journal-title":"J Kidney Care."},{"key":"B21","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1159\/000046215","article-title":"Adult-onset minimal change disease among Taiwanese","volume":"21","author":"Huang","year":"2001","journal-title":"Am J Nephrol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s12882-016-0303-x","article-title":"Microvascular endothelial dysfunction is associated with albuminuria and CKD in older adults","volume":"17","author":"Seliger","year":"2016","journal-title":"BMC Nephrol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"S50","DOI":"10.1046\/j.1523-1755.63.s84.2.x","article-title":"Endothelium-dependent vasodilation and oxidative stress in chronic renal failure: impact on cardiovascular disease","volume":"63","author":"Annuk","year":"2003","journal-title":"Kidney Int."},{"key":"B24","doi-asserted-by":"publisher","first-page":"CD008176","DOI":"10.1002\/14651858.CD008176.pub2","article-title":"Antioxidants for chronic kidney disease","volume":"10","author":"Jun","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"B25","doi-asserted-by":"publisher","first-page":"3345","DOI":"10.1681\/ASN.2017030228","article-title":"The loss of GSTM1 associates with kidney failure and heart failure","volume":"28","author":"Tin","year":"2017","journal-title":"J Am Soc Nephrol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"3140","DOI":"10.1681\/ASN.2015050487","article-title":"Le combined effects of GSTM1 null allele and APOL1 renal risk alleles in CKD Progression in THE African American Study of Kidney Disease and Hypertension Trial","volume":"27","author":"Bodonyi-Kovacs","year":"2016","journal-title":"J Am Soc Nephrol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"F348","DOI":"10.1152\/ajprenal.00568.2012","article-title":"Loss of GSTM1, a NRF2 target, is associated with accelerated progression of hypertensive kidney disease in the African American Study of Kidney Disease (AASK)","volume":"314","author":"Chang","year":"2013","journal-title":"Am J Physiol Renal Physiol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1681\/ASN.2019050449","article-title":"GSTM1 deletion exaggerates kidney injury in experimental mouse models and confers the protective effect of cruciferous vegetables in mice and humans","volume":"31","author":"Gigliotti","year":"2020","journal-title":"JASN."},{"key":"B29","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1016\/j.etp.2010.11.005","article-title":"Protective effect of sulforaphane against oxidative stress: recent advances","volume":"64","author":"Guerrero-Beltr\u00e1na","year":"2012","journal-title":"Exp Toxicologic Pathol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1681\/ASN.2006090965","article-title":"Active focal segmental glomerulosclerosis is associated with massive oxidation of plasma albumin","volume":"18","author":"Musante","year":"2007","journal-title":"J Am Soc Nephrol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.614948\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T04:46:34Z","timestamp":1620103594000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.614948\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,4]]},"references-count":30,"alternative-id":["10.3389\/fped.2021.614948"],"URL":"https:\/\/doi.org\/10.3389\/fped.2021.614948","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,4]]},"article-number":"614948"}}