Minimal Change Disease

Question 1

Pathophysiology

Answer 1

Interaction between intrinsic structural defects and immunologic disturbances
Podocytopathy- effacement of podocyte foot processes (hallmark of MCD)
Elevated t17/treg cell ratio

Question 2

Secondary causes

Answer 2

Hematologic Tumors
Hodgkin lymphoma
Non-Hodgkin lymphoma
Leukemia

Solid Tumors
Thymoma
Renal cell carcinoma
Lung carcinoma
Mesothelioma

Infection
Syphilis
Mycoplasma
Ehrlichiosis
Strongyloidiasis
Echinococcus
Tuberculosis
HIV
Hepatitis C virus

Drugs
NSAIDs, including COX-2 inhibitors
Antimicrobials (ampicillin, rifampicin, cephalosporins)
Lithium
D-penicillamine
Bisphosphonates (Pamidronate)
Sulfasalazines (mesalazine and salazopyrine)
Trimethadione
Immunizations
Interferon-y

Other Kidney and Systemic Diseases
SLE
Fabry disease
Polycystic kidney disease
IPEX syndrome

Question 3

Clinical presentation

Answer 3

Nephrotic-Range proteinuria, edema,hypalbumenia, hypercholedteremia

Question 4

Treatment

Answer 4

Steroids

Question 5

Long Term treatment (steroid not effective)

Answer 5

Cyclophosphamide
Mycophenolate mofetil
Cyclosporine
Tacrolismus
Rituximab