Background: A 61-year-old woman received standard immunizations, including Haemophilus influenzae type B, diphtheria, tetanus toxoid, and unconjugated 23-valent pneumococcal vaccine (Pneumovax), Merck & Co., Inc., Whitehouse Station, NJ), 1 year after undergoing nonmyeloablative hematopoietic stem-cell transplantation for acute myelogenous leukemia. After 5 days, she developed fatigue with progressive weight gain and edema, and 14 days after immunization she presented with anasarca and was found to have acute renal failure and nephrotic proteinuria.
Investigations: Physical examination, serum chemistry, examination of urine sediment, renal ultrasound using Doppler scanning, 24 h urine collection, and renal biopsy.
Diagnosis: Minimal-change nephrotic syndrome with acute tubular injury.
Management: Aggressive diuresis and oral corticosteroid therapy.