Saudi Journal of Kidney Diseases and Transplantation

: 2011  |  Volume : 22  |  Issue : 3  |  Page : 571--572

Author's reply

Mazin M.T Shigidi 
 Nephrology Division, Department of Medicine, Al Ribat University Hospital, Khartoum, Sudan

Correspondence Address:
Mazin M.T Shigidi
Nephrology Division, Department of Medicine, Al Ribat University Hospital, Khartoum

How to cite this article:
Shigidi MM. Author's reply.Saudi J Kidney Dis Transpl 2011;22:571-572

How to cite this URL:
Shigidi MM. Author's reply. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2022 Nov 28 ];22:571-572
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Full Text

To the Editor,

Unlike what is seen in children, adult minimal change disease (MCD) is a rare disease accounting for only 10-15% of cases of adult primary nephrotic syndrome (NS). [1],[2] Most cases of NS seen in adults are secondary to diabetes mellitus, connective tissue diseases, infections, malignancies, drugs or toxins.

Indeed in a city like Khartoum, various tropical allergens are expected to be present in the air, food, soil and from parasitic infestations which might be triggering agents for relapsing minimal change nephrotic syndrome. [3],[4],[5],[6] In general practice, an intensive work-up is done for all adults with NS to rule out a primary cause; this includes a detailed history, thorough clinical examination and an exhaustive list of general and specific investigations, considering the possibility an allergen-induced immune response as well. Once an adult is labeled as having a primary glomerular disease, an initial kidney biopsy is mandatory. Repeat biopsies are always considered in those who fail to respond to steroids or other immuno-suppressants. [7]

It seems interesting to look in depth in adults with relapsing MCNS, their serum IgE levels and their sensitivity to food antigens by skin testing, radioallergosorbent or basophil degranulation, though not commonly applied in clinical practice.

Overall, it is always important to consider an alternative diagnosis in adults with primary minimal change nephrotic syndrome, who fail to respond to treatment or follow an atypical course. [7]


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2Zech P, Colon S, Pointet P, Deteix P, Labeeuw M, Leitienne P. The nephritic syndrome in adults aged over 60: Etiology, evolution and treatment of 76 cases. Clin Nephrol 1982;17: 232-6.
3Ahmed AH, Bilal IE, Merghani TH. Effects of exposure to flour dust on respiratory symptoms and lung function of bakery workers: a case control study. Sudanese J Public Health 2009; 4(1):210-3.
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6Laurent J, Rostoker G, Robeva R, Bruneau C, Lagrue G. Is adult idiopathic nephrotic syndrome food allergy? Value of oligo-antigenic diets. Nephron 1987;47(1):7-11
7Waldman M, Crew RJ, Valeri A, et al. Adult minimal-change disease: clinical characteristics, treatment, and outcomes. Clin J Am Soc Nephrol 2007;2:445-53.