Wednesday, 10 November 2010

MRCP revision battle 45.7: Minimal change glomerulonephritis

Minimal change glomerulonephritis almost always presents as nephrotic syndrome

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.