Minimal Change Disease and Metabolic Syndrome: A Therapeutic Challenge in a Young Adult Male

By Ambra METASANA, Amantia IMERAJ, Ariana STRAKOSHA

Abstract
Minimal Change Disease (MCD) is a podocytopathy most commonly diagnosed in children and less frequently in adults, where the clinical course tends to be more complicated and variable. In adults, the disease often demonstrates delayed responsiveness to corticosteroids, higher relapse rates, and an increased likelihood of requiring alternative forms of immunosuppression to achieve remission. When MCD occurs together with metabolic syndrome—a cluster of metabolic abnormalities including central obesity, dyslipidemia, hypertension, and hepatic steatosis—the condition becomes even more challenging to manage. The combination creates a vicious cycle in which metabolic dysfunction aggravates glomerular injury while renal impairment worsens cardiometabolic status. In this case, we describe a 21-year-old male who presented with nephrotic-range proteinuria and severe metabolic derangements. Renal biopsy revealed MCD, and treatment required a highly individualized approach in order to preserve renal function while avoiding the detrimental metabolic consequences associated with high-dose steroid therapy. Rituximab was introduced early as part of a steroid-sparing strategy, resulting in a favorable clinical response. This case highlights the significance of personalized immunosuppressive therapy, long-term metabolic control, and multidisciplinary care in preventing irreversible renal and cardiovascular outcomes in young adults living with both MCD and metabolic syndrome.