Nephrotic syndrome in children is a common recurrent disease. Most of the cases are due to minimal change disease with a favourable outcome. More than 90% of children with minimal change disease respond to corticosteroid therapy (steroid sensitive nephrotic syndrome). 40–60% experience frequent relapses or have steroid dependence. These children require frequent corticosteroid therapy andJor immunomodulators or treatment with immunosuppressants, and are at high risk of cumulative steroid toxicity and side effects of cytotoxic therapy. Children with frequent relapses or steroid dependence should be managed in consultation with a pediatric nephrologist. Despite relapsing course, progression of minimal change nephrotic syndrome to end stage renal disease is extremely rare.
Furthermore, the present case was complicated by chronic thyroiditis, as demonstrated by diffuse hard goitre and positive anti-thyroid peroxidase antibodies. Sarcoidosis is often complicated by autoimmune thyroid diseases. Nakamura et al. [ 8 ] recently reported on the high prevalence of autoantibodies against thyroid peroxidase and thyroglobulin in Japanese patients with sarcoidosis. Mündlein et al. [ 2 ] observed the simultaneous occurrence of Graves' disease and sarcoidosis in a patient with minimal-change glomerulonephritis which was steroid-sensitive, and speculated that a disruption of the immunoregulatory network provided a causal link between these disorders. Taken together, we propose that the simultaneous occurence steroid-sensitive nephrotic syndrome of sarcoidosis and of autoimmune thyroid disease constitutes a new syndrome.