Disclosures: Matthew A. Cascio, DO: No financial relationships or conflicts of interest

Case Diagnosis: Minimal Change Disease

Case Description or Program Description: An 80-year- old female presented to PM&R clinic, referred by nephrology, for management of lower extremity edema secondary to newly diagnosed Minimal Change Disease (MCD). She experienced 1.5 years of unexplained lower extremity swelling, with recent renal biopsy demonstrating MCD. Her lower extremity swelling caused difficulty raising her legs, severely limiting her activities of daily living (ADLs). She tried physical therapy and compression stockings with minimal improvement in her swelling or function. She recently initiated treatment with prednisone. Physical exam demonstrated 3+ pitting edema in the bilateral lower extremities and 3/5 strength in bilateral hip flexion. She ambulated with a rolling walker.

Setting: Tertiary-care teaching hospital

Assessment/Results: She was prescribed occupational therapy for lymphedema management, and received manual lymphatic drainage and compression bandaging twice weekly over three months. All lower extremity measurements decreased and hip flexion improved to 5/5. She now ambulates independently with improvement in ADLs. She has lost 64 pounds since initial visit.

Discussion (relevance): MCD is a major cause of nephrotic syndrome in children (90%) and a minority of adults (10%). Pathogenesis involves T cell dysfunction causing the production of a glomerular permeability factor, which leads to proteinuria and foot process effacement. Presentation involves sudden onset nephrotic syndrome with proteinuria and lower extremity edema. A kidney biopsy is required for MCD diagnosis in adults. Treatment involves glucocorticoids, leading to complete remission in most patients. While modalities including manual lymphatic drainage have proven efficacious in other etiologies of lymphedema including breast cancer, such modalities have not yet been well studied in nephrotic syndrome treatment.

Conclusions: Occupational therapy with manual drainage and compression bandaging in conjunction with oral steroid treatment reduced lymphedema in our patient with MCD. Such modalities should be considered in MCD treatment and should be further studied.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-opportunity-for-change-a-case-of-occupational-therapy-in-the-management-of-minimal-change-disease/