Minimal lesion disease followed by membranous glomerulonephropathy in two children with nephrotic syndrome.

Two children with nephrotic syndrome are described whose clinical course, initial response to steroids, and renal biopsies were consistent with a diagnosis of minimal lesion disease (MLD). Both children subsequently became resistant to steroids and repeat renal biopsies 7 and 8 years after initial biopsies showed membranous glomerulonephropathy (MGN). Explanations are suggested which may account for the occurrence of MLD followed by MGN in a single patient. These cases illustrate the necessity of performing repeat renal biopsies in patients with nephrotic syndrome if the clinical behavior and response to steroids are not typical for MLD.