Minimal Change Disease

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Summary1)Fundamentals of Pathology by Hussain Sattar

Minimal Change Disease is the most common cause of nephrotic syndrome in children.

Pathophysiology2)Fundamentals of Pathology by Hussain Sattar

Histology – Effacement of the epithelial cell foot processes (University of Utah Healthcare)

The pathology of minimal change disease is unclear and is currently considered idiopathic. The pathology does not appear to involve complement, immunoglobulins, or immune complex deposition. Rather, an altered cell-mediated immunologic response with abnormal secretion of lymphokines by T cells is thought to reduce the production of anions in the glomerular basement membrane, thereby increasing the glomerular permeability to serum albumin through a reduction of electrostatic repulsion.

The loss of anionic charges is also thought to favor foot process fusion. The etiological agent is somewhat of a mystery but viruses such as EBV, and food allergies have been implicated. Also, the exact cytokine responsible has yet to be elucidated, with IL-12, IL-18 and IL-13 having been most studied in this regard, yet never conclusively implicated.

Causes3)Fundamentals of Pathology by Hussain Sattar

  • Idiopathic but maybe associated with Hodgkin’s Lymphoma

Symptoms 4)First Aid for the Basic Sciences: Organ Systems by Tao Le

  • Nephrotic Syndrome without hypertension
  • Selective proteinuria

Diagnosis 5)First Aid for the Basic Sciences: Organ Systems by Tao Le

  • Renal Biopsy – lipoid nephrosis, effacement of visceral epithelial foot processes and increased lipoproteins in the PCT’s

Diagram of a glomerular affected with Minimal Change Disease (Students of Medicine Plus)

Treatment 6)First Aid for the Basic Sciences: Organ Systems by Tao Le

  • Corticosteroids
  • Alkylating Agents

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