Minimal Change Disease
Minimal change disease is the most common cause of the nephrotic
syndrome in childhood.
In a prospective study of untreated children with
the nephrotic syndrome, minimal change disease was found in 76.6%.
In contrast, minimal change disease accounts for only 10% to 30% of
adult cases of nephrotic syndrome. In both children and adults these
percentages vary in different parts of the world. The clinical onset of
nephrotic syndrome may be associated with an upper respiratory infection
or with routine prophylactic immunizations. Other genetic and
environmental factors may also be important.
Most patients with minimal change disease develop mild periorbital
edema as the initial complaint.
The proteinuria in minimal change disease is said to be
"selective", that is composed primarily of albumin.
Microscopic hematuria is rare with reported frequencies of 13 to 36%,
and hypertension is also unusual in minimal change disease.
Most patients (90%) respond to an 8 week course of steroids. Cytotoxic agents may be used in steroid resistant cases (~10%). Renal failure from minimal change disease is rare, but relapses are common.