ISSN: 1305-385X
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Minimal Change Disease
Dr. Mustafa BALALa
aNefroloji BD, Çukurova Üniversitesi Tıp Fakültesi, ADANA
Minimal Change Disease is associated with a completely normal appearance in the glomeruli on light microscopy but podocyte foot process effacement seen with electron microscopy. It accounts for 90% cases idiopathic nephrotic syndrome in children and 10-15% of cases in adults. In a minority of patients with MCD, there is a clear association with a factor that appears to provoke the nephrotic syndrome. Although the injury is manifested as a change in glomerular capillary permeability, it is probable that the underlying problem is toxic epithelial cell injury, which results in foot process fusion and epithelial cell detachment and alters capillary wall function. There is increasing circumstantial evidence that circulating factor is involved in the pathogenesis and that there may be an abnormality of cell-mediated immunity. Mild mesangial hypercellularity is now accepted a finding and small amounts of mesangial IgG, IgM, complement C3 and occasionally IgA are sometimes seen in patients with MCD. Glomerular size is usually normal and enlarged but otherwise normal appearing glomeruli may be predictive of steroid unresponsiveness or subsequent development of FSGS.
The clinical signs and symptoms are the same as those for the the nephrotic syndrome from any cause although, the nephrotic syndrome may be of very rapid onset, increasing the risk of hypovolemia, particularly in children. The first step for therapy is the usage of corticosteroids in child and adults. The use of cyclophosphamide may be ensure remission in those patients with frequently relapsing, steroid-dependent or steroid-resistant MCD. Cyclosporine is a reasonable option for patients who have a relapse after one or two courses of cyclophosphamide therapy. But, relaps occurs in approximately 70% of patients after cyclosporine was discontinued. Renal biopsy is advisable in patients requiring cyclosporine treatment for more than 1 year.Keywords: Minimal change disease, treatmentTurkiye Klinikleri J Int Med Sci 2006, 2(21):10-14
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