Minimal change disease is the commonest cause of nephrotic syndrome in children and accounts for 15% of cases of primary nephrotic syndrome in adults.
It is usually idiopathic but it can occasionally be secondary to:
- Neoplasia – notable Hodgkins and non-Hodgkins lymphoma
- Drugs – including NSAIDS, lithium, rifampicin, gold and tamoxifen
- Infections – including TB, syphilis, HIV and mycoplasma
- Atopic reactions
It is believed to be T cell mediated.
It is known as minimal change disease because under the light microscope no change is seen but with an electron microscope you can see effacement of the podocyte processes.
Treatment
- Oral corticosteroids - around 70% of patients respond to steroids
- Second line: Cyclophosphamide, cyclosporine, tacrolimus
Prognosis:
- Around a third make a complete recovery
- A third have one relapse
- A third have more than one relapse
Complications are essentially the same as those of nephrotic syndrome:
- Thrombosis
- Infection
- Acute renal failure
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