A 6 year old boy is brought to the pediatrician by his mother because of a puffy face and lethargy. A few weeks before, he had an upper respiratory tract infection, probably caused by a virus .Body temperature is 36.8 degree centigrade, BP was 95/65 and heart rate was 90 bpm. Puffiness around the eyes, abdominal swelling and pitting edema in the legs are observed. A urine sample (dipstick) is negative for glucose but reveals 3+ protein. Microscopic examination of the urine reveals no cellular elements or casts. Plasma (Na) 140 mEq/L; BUN 10mg/dL; glucose 100mg/dL; Cr 0.8 mg/dL; serum albumin 2.3 g/dL and cholesterol 330 mg/dl. 24 hour urine sample has a volume of 1.10 L and contain 10 mEq/L Na+, 60mg/dL creatatine and 0.8 g/dL protein. Child is treated with the corticosteroid and prednisone, and the edema and proteinuria disappear in 2 weeks. Puffiness and proteinuria recur 4 months later, and a renal biopsy is performed. Glomeruli are normal by light microscopy, but effacement of podocyte foot processes and loss filtration slits are seen whit the electron microscope .No immune deposits or complement are seen after immunostaining. The biopsy indicates minimal change glomerulopathy. The podocyte cell surface and glomerular basement membrane show reduced staining with a cationic dye.

What features in this case would cause the suspension of nephrotic syndrome and what is the explanation for the proteinuria?

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