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Minimal Change Disease

by | 15 Apr, 2021

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Introduction

Minimal change disease produces glomerulonephritis with clinical features consistent with nephrotic syndrome. It is the commonest cause of nephropathy in children, accounting for 80% of cases. In addition, minimal change disease accounts for 20% of nephropathies in adults.

Causes

Most cases of minimal change disease are idiopathic. Secondary causes include:

  • Drugs e.g. NSAIDs, lithium
  • Infections e.g. syphilis, tuberculosis
  • Paraneoplastic e.g. leukaemia, lymphoma

Clinical features

Minimal change disease presents with nephrotic syndrome, including proteinuria and oedema. Symptoms and signs include:

  • Frothy urine: due to hyperlipidaemia and fatty casts in urine
  • ↑ Risk of thromboembolism: due to loss of antithrombin III in urine
  • ↑ Risk of infection: due to loss of IgG and tissue oedema, which compromises the local blood supply and immune response)
  • Generalised symptoms, including fatigue and reduced appetite

Investigations

Investigations should include urine tests and blood tests as usually used when investigating nephrotic syndrome. While kidney biopsy is not usually required in children as diagnosis can be made on clinical grounds given its incidence in the paediatric population, performing a biopsy should be considered in adults.

Urine tests

Urine tests will show proteinuria and high albumin:creatinine ratio. Tests include:

  • Urine dipstick
  • Urine microscopy and culture
  • Urine albumin:creatinine ratio

Blood tests

Blood tests are used to check for features of nephrotic syndrome as well as exclude other causes.

  • Urea and electrolytes
  • Full blood count
  • C-reactive protein
  • ESR
  • HbA1C
  • Cholesterol and triglyceride levels
  • Immunology:
    • Complement levels
    • ANCA
    • ANA
    • Anti-dsDNA
    • Anti-GBM
    • ASOT

Biopsy findings

Light microscopy shows normal histology in minimal change disease. However, electron microscopy would show deformities of podocyte foot processes.

Management

Corticosteroids are first-line and are effective in 80% of cases. Additional drug therapies include the use of cyclophosphamide and cyclosporine.

Prognosis

Minimal change disease has good prognosis in both children and adults in steroid-responsive cases.

References

  • https://www.ncbi.nlm.nih.gov/books/NBK560639/

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