Minimal change disease

Minimal change nephropathy is responsible for 90% of the cases of nephrotic syndrome in children less than 5 years of age. It also occurs in adults - approximately 20%.

The name is derived from the fact that the only detectable abnormality histologically is fusion and deformity of the foot processes under the electron microscope. Both light microscopy and immunofluorescence are unremarkable.

The condition is most frequent in children aged between two and four years. It has been suggested that MCD is more common in atopic patients, especially those possessing HLA-DR7. However, a direct link between allergic sensitisation and the onset of MCD is yet to be established.

MCD is steroid-responsive and, in general, does not lead to chronic renal failure.

With respect to interventions for MCD in adults a systematic review concluded (1):

• calcineurin inhibitors and enteric-coated mycophenolate sodium may be effective in achieving remission in adults with nephrotic syndrome due to MCD with some reduction in the side effects of high dose prednisolone therapy

Reference:

• Azukaitis K, Palmer SC, Strippoli GFM, Hodson EM. Interventions for minimal change disease in adults with nephrotic syndrome. Cochrane Database of Systematic Reviews 2022, Issue 3. Art. No.: CD001537. DOI: 10.1002/14651858.CD001537.pub5