minimal change disease

Question 1

what are the features of MCD?

Answer 1

nephrotic syndrome- 75% kids, 25% adults
normotension
highly selective proteinuria - intermediate size proteins eg albumin + transferrin leak through glomerulusw

Question 2

what are renal biopsy features of MCD?

Answer 2

normal glomeruli on light microscopy
electron microscopy shows fusion of podocytes + effacement of foot processes

Question 3

what are the causes of MCD?

Answer 3

majority idiopathic 80%
drugs- NSAIDs, rifampicin
hodgkins lymphoma
thymoma
infectious mononucleosis

Question 4

what is the pathophysiology of MCD?

Answer 4

T-cell + cytokine-mediated damage to glomerular basement membrane leads to polyanion loss

resultant reduction of electrostatic charge leads to increased glomerular permeability to serum albumin

Question 5

what is the management of MCD?

Answer 5

oral corticosteroids- 80% cases steroid-responsive

cyclophosphamide if steroid-resistant

consider renal biopsy if response to steroids is poor

Question 6

what is the prognosis of MCD?

Answer 6

overall good but relapse common
1/3 have 1 episode
1/3 have infrequent relapses
1/3 have frequent relapses which stop before adulthood

Question 7

what are the urine dipstick /investigation findings of MCD?

Answer 7

proteinuria but no haematuria

low serum albumin