Tuberculosis and minimal change nephropathy.

A patient with minimal change nephropathy (MCN) is described who, during the earlier part of his illness, had several relapses each of which promptly responded to treatment with prednisolone but subsequently his proteinuria became refractory to this treatment for nearly two years. Tuberculous osteitis was then discovered and treated. Thereafter, a further course of prednisolone caused a prompt and sustained remission. The natural history of this patient identifies another cause of failure of conventional therapy to induce remission in patients with MNC; highlights the hazards of that therapy; suggests that neither prednisolone nor cyclophosphamide is capable of inhibiting the mechanism causing proteinuria unless the provoking factor has been eliminated and supports Shalhoub's belief that the T lymphocyte may be important in the pathogenesis of MCN.