It is responsible for 80% of cases of nephrotic syndrome in children and around a quarter of cases in adults.
Its name 'minimal change' comes from the fact that under a light microscope the kidney looks normal; if an electron microscope is used you can see podocyte fusion.
Minimal change glomerulonephritis causes a highly selective proteinuria with only smaller proteins leaked.
Most causes are idiopathic but 10-20% are associated with:
- NSAIDs/gold/rifampacin
- hodgkins, thyroma
- mononucleosis
It is believed to be T-lymphocyte mediated.
Treatment is with corticosteroids - 80% of cases respond
Cyclophosphamide can be used in non-responders.
The prognosis for minimal change glomerulonephritis is (fairly) good:
- 1/3 recover completely
- 1/3 suffer infrequent relapses
- 1/3 suffer frequent relapses
- BUT - <1% proceed to end-stage renal failure
Tomorrow's battles will be a completely random bag, then a final renal push (the end of the hattrick) will occur the day after.
