DR Medhat MRCP

Minimal Change disease (MCD)
- Nearly always presents as nephrotic syndrome.
- Accounting for 75% of cases in children and 25% in adults
Pathogenesis (uncertain) :
- Altered T lymphocyte activity and production of a glomerular permeability factor (
podocyte dysfunction) .
- Albuminuria essentially results from a failure of the glomerular filter.
Causes:
Features :
Majority of cases are idiopathic, but in around 10-20% a cause is found.
Drugs : NSAIDs (most common) , rifampicin ,lithium,bisphosphonates,…etc.
Hodgkin's lymphoma, NHL and thymoma.
Infections (rare) : IMN, TB,HIV,HCV.
Atopy (30% of MCD cases).
Nephrotic syndrome
Normotension (hypertension is rare).
Hematuria is very rare.
Highly selective proteinuria*(Albuminuria).
Clinical picture :
General C/P of nephrotic syndrome ( remember: no or rare hematuria).
Venous thrombosis : e.g renal vein thrombosis , DVT.
Immunity infections (esp. skin & soft tissue).
Abdominal pain (SBP) ± hypotension (intravascular volume depletion).
AKI : (2ndry to ATI).
Investigations :
SCr, eGFR , U&E , albumin , LFT, bone profile, cholesterol.
uPCR or uACR (tests for selective proteinuria may be helpful).
Urine R/M : (may show lipid bodies, hyaline or granular casts).
Renal biopsy in adults.
Renal pathology :
LM : normal or near normal glomerulus , lipid droplets in tubular cells.
EM :shows fusion (effacement) of podocytes
IF : negative.
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