Minimal Change Disease

Exam Cram

• Minimal change disease is the commonest cause of nephrotic syndrome in children 

• Renal biopsy shows 'minimal change', hence the name

• Presentation: < 18yrs, facial and peripheral oedema, proteinuria

• Management: steroids

Outline

Background 

• Commonest cause of childhood nephrotic syndrome. 

• Good prognosis- 1/3rd only have one episode, 1/3 infrequent relapses and 1/3 have frequent relapses into childhood

Assessment

History:

• Gradual onset of lethargy & swelling

Examination:

• Swelling

  • Classically on face

  • Peripheral oedema

Investigations

• Urine analysis: proteinuria

• Hyperlipidemia

Diagnosis

Diagnostic criteria: 

• Usually made clinically: nephrotic in under 18yrs

• Due to young age and diagnostic confidence a renal biopsy is often avoided

Differentials: Membranous Nephropathy: age > 18yrs at diagnosis

Management

1. Prednisolone

2. Azathiopine

Med Reg Notes

Management

The majority of nephrotic syndromes are managed with: anticoagulation, statins, ACEi and require a kidney biopsy to diagnose the cause. In Minimal Change Disease, ACEi aren't used and because of the difficulty of doing a kidney biopsy in a child and high clinical certainty, these are often managed empirically and successfully with only steroids.

6 weeks of steroids are trialed and if this fails, move onto DMARDs, e.g. Azathioprine. 

References

Page written in 2024. 

Produced off FOAM basis: free, open access, medical education. This is not clinical advice, education for multiple choice questions only! 

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