Etiology, clinical features, and diagnosis of minimal change disease in adults
- Alain Meyrier, MD
Alain Meyrier, MD
- Professor of Medicine (Emeritus)
- Université Paris-Descartes, Paris, France
- Jai Radhakrishnan, MD, MS
Jai Radhakrishnan, MD, MS
- Professor of Medicine
- Columbia University Medical Center
- Section Editors
- Richard J Glassock, MD, MACP
Richard J Glassock, MD, MACP
- Editor-in-Chief — Nephrology
- Section Editor — Glomerular Diseases
- Emeritus Professor
- The David Geffen School of Medicine at UCLA
- Fernando C Fervenza, MD, PhD
Fernando C Fervenza, MD, PhD
- Section Editor — Glomerular Diseases
- Professor of Medicine
- Mayo Clinic College of Medicine
Minimal change disease (MCD) is a major cause of nephrotic syndrome (approximately 90 percent) in children and in a minority of adults (approximately 10 percent). MCD and focal segmental glomerulosclerosis (FSGS) are both examples of pathogenic mechanisms that primarily affect the podocyte ("podocytopathies"). These entities are not characterized by immune deposits, but there may be a role for circulating factors in the pathogenesis of both diseases. (See 'Pathogenesis' below and 'Primary MCD versus primary FSGS' below.)
The pathogenesis, etiology, causes, and diagnosis of MCD in adults will be reviewed here. The treatment of MCD as well as the pathogenesis, diagnosis, and treatment of FSGS are discussed separately. (See "Treatment of minimal change disease in adults" and "Epidemiology, classification, and pathogenesis of focal segmental glomerulosclerosis" and "Treatment of primary focal segmental glomerulosclerosis".)
MCD is the most common cause of nephrotic syndrome in children, with variations in incidence based upon age [1-3] (see "Etiology, clinical manifestations, and diagnosis of nephrotic syndrome in children", section on 'Idiopathic nephrotic syndrome'):
●Among children under age 10 years who present with idiopathic nephrotic syndrome, MCD is the underlying disease in approximately 90 percent.
●Among children over age 10 years, MCD accounts for only 50 percent of cases with an increased percentage of focal segmental glomerulosclerosis (FSGS) in this age group.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- T cell dysfunction
- B cell dysfunction
- Glomerular permeability factor
- Role of the glomerular basement membrane
- Role of the slit diaphragm
- Genetic disease
- Other glomerular diseases
- Other etiologies
- CLINICAL MANIFESTATIONS
- Differential diagnosis
- - Primary MCD versus primary FSGS
- MCD in the older adult
- MCD and acute kidney injury