Minimal change disease Flashcards
(4 cards)
What is minimal change nephropathy
Glomerular disease with little/no change on light microscopy
Effacement of foot processes by EM (fusion, swelling), obliteration of flitration slit pores
No Ig or complement deposits
Clinical course of minimal change nephropathy
Most common in <5yr males
Most common cause of primary nephrotic syndrome in pre-adolescents
Severe and selective proteinuria (usu albumin), hypoalbuminaemia, oedema, hypercholesterolaemia
Almost always presents with oedema - be careful diagnosing MCD in subnephrotic proteinuria
Can be remitting relapsing
Remits with corticosteroids, cyclophosphamide, reversible, rarely leads to end stage renal failure
Acute renal failure uncommon in children, more in adults (usu due to hypovolaemia)
Hiistology of MCN
May be none
Podocyte swelling
Porotein and lipid resorption droplets in proximal tubules
No tubular atrophy or interstitial fibrosis (may see in adults due to arteriosclerosis)
Normal glomerular BM thickness
Interstitial foam cells rare, isolated
Mild interstitial inflammation (if severe, think acute interstitial nephritis due to NSAIDs)
IF - no change, or weak mesangial IgM, albumin in proximal tubular cell resorption droplets
In minority of cases esp in kids, may be mesangial Igs and complement - may confer worse prognosis
Variants of MCD
Diffuse mesangial hypercellularity
IgM nephropathy - mesangial IgM
MCD with acute renal failure
Secondary MCD - NSAIDs, lithlium
NSAIDs causes interstitial nephritis (lymphocytes), oedema
Ass with malignancies esp Hodgekin’s
