Minimal Change Disease

Key points

• Minimal change disease nearly always presents as nephrotic syndrome, accounting for 75% of cases in children and 25% in adults. The majority of cases are idiopathic, but in around 10-20% a cause is found:
• infectious mononucleosis
• T-cell and cytokine-mediated damage to the glomerular basement membrane - polyanion loss
• the resultant reduction of electrostatic charge - increased glomerular permeability to serum albumin
• normotension - hypertension is rare
• highly selective proteinuria o only intermediate-sized proteins such as albumin and transferrin leak through the glomerulus