Minimal Change Disease

Question 1

How does minimal change disease always present & what aare it’s features?

Answer 1

As nephrotic syndrome.

Normotension - hypertension is rare.

Proteinuria

Question 2

Does minimal change disease more commonly cause nephrotic syndrome in adults or in children?

Answer 2

In children.

~75-80% of cases of nephrotic syndrome in children are due to minimal change disease.

25% of nephrotic syndrome in adults is due to minimal change disease cases

Question 3

What is the cause of minimal change disease in most cases?

Answer 3

Idiopathic

Question 4

In rare cases (10-20%), what can the cause?

Answer 4

• Drugs: NSAIDs, Rifampicin
• Hodkin’s lymphoma, thymoma
• Infectious mononucleosis

Question 5

What is the pathophysiology of minimal change disease?

Answer 5

• T-cells and cytokines damage the glomerular basement membrane and the glomerulus becomes permeable to serum albumin.

Question 6

What is the investigation to diagnose it?

Answer 6

Renal biopsy - shows fusion podocytes

Question 7

What is the management?

Answer 7

• Steroids - most cases responsive to this (80%)
• Cyclophosphamide is second line.

Question 8

What is the prognosis of minimal change disease?

Answer 8

• 1/3 have just one episode
• 1/3 have infrequent relapses
• 1/3 have frequent relapses which stop before adulthood.