eMedicine Specialties > Nephrology > Glomerular Diseases

Minimal-Change Disease: Follow-up

Author: Abeera Mansur, MD, Consultant Nephrologist, Doctors Hospital and Medical Center, Pakistan
Coauthor(s): Florin Georgescu, MD, Consulting Staff, Kidney Specialists of Savannah; Susie Lew, MD, Professor, Department of Medicine, Division of Renal Diseases and Hypertension and Nephrology, George Washington University Medical Center
Contributor Information and Disclosures

Updated: Oct 15, 2009

Follow-up

Further Inpatient Care

  • Patients are treated in an outpatient setting. Complications of MCD may require admission.

Further Outpatient Care

  • Carefully monitor medication doses and adverse effects.
  • Monitor vital signs for possible onset of hypertension.
  • Monitor volume status.
  • Monitor for signs of infection.

Complications

  • The most common complications are from the adverse effects of medications.
  • Additional complications may include peritonitis, infections, and acute renal failure. Acute renal failure occurs because of either acute tubular necrosis or acute tubulointerstitial nephritis. In a retrospective review of 95 adult patients with MCD, Waldman et al reported that 24 patients had acute renal failure, with these individuals tending to be older and hypertensive, and to have lower serum albumin and more proteinuria than did patients who did not suffer acute renal failure.11
  • Patients with nephrotic syndrome have an increased incidence of arterial and venous thromboemboli, particularly deep vein and renal vein thrombosis. Renal vein thrombosis is known to occur in patients with MCD, although the incidence is lower than in patients with membranous nephropathy.
  • Hypercholesterolemia and hypertriglyceridemia can lead to accelerated atherosclerosis and perhaps cause progressive glomerular injury.

Prognosis

  • Use of antibiotics and glucocorticoids and better-organized schedules of management have substantially reduced the mortality rates associated with MCD. Deaths still occur from disease complications.
  • Relapses eventually cease. Only approximately 5% of children continue to have steroid-responsive relapses when older than 18 years.
  • Adults have a similarly good prognosis. Survival rates of 85-90% are observed 10 years or more after disease onset.
  • Chronic renal failure is extremely rare in patients who are steroid-responsive. If chronic renal failure occurs, the possibility that the pathologic lesion is different or has evolved must be considered.

Patient Education

  • Family members should be observant for edematous changes in the patient.
  • Refer the patient and family for psychosocial counseling.
  • Impose moderate sodium restrictions and ensure adequate protein intake.

Miscellaneous

Medicolegal Pitfalls

  • Explain to the family that children initially are treated without a tissue diagnosis.
  • FSGS may be misdiagnosed as MCNS because of sampling error.
  • Complications may occur due to immunosuppressive therapy.
  • A secondary treatable cause may be overlooked.
  • Explain the consequences of not receiving treatment for MCD. Also explain that not all patients receiving treatment respond to conventional therapies.

Special Concerns

  • In addition to other adverse effects, growth retardation can occur with steroid use in children.
 


More on Minimal-Change Disease

Overview: Minimal-Change Disease
Differential Diagnoses & Workup: Minimal-Change Disease
Treatment & Medication: Minimal-Change Disease
Follow-up: Minimal-Change Disease
References
Further Reading
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References

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Keywords

minimal-change disease, nephrotic syndrome, focal segmental glomerulosclerosis, idiopathic nephrotic syndrome of childhood, lipoid nephrosis, minimal-change nephropathy, minimal-change nephrotic syndrome, nil disease, steroid-sensitive nephrotic syndrome

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Contributor Information and Disclosures

Author

Abeera Mansur, MD, Consultant Nephrologist, Doctors Hospital and Medical Center, Pakistan
Abeera Mansur, MD is a member of the following medical societies: American College of Physicians and American Society of Nephrology
Disclosure: Nothing to disclose.

Coauthor(s)

Florin Georgescu, MD, Consulting Staff, Kidney Specialists of Savannah
Florin Georgescu, MD is a member of the following medical societies: American College of Physicians, American Medical Association, and American Society of Nephrology
Disclosure: Nothing to disclose.

Susie Lew, MD, Professor, Department of Medicine, Division of Renal Diseases and Hypertension and Nephrology, George Washington University Medical Center
Susie Lew, MD is a member of the following medical societies: American College of Physicians, American Society of Nephrology, International Society of Nephrology, and National Kidney Foundation
Disclosure: Amgen Consulting fee Consulting; Amgen Grant/research funds investigator; Amgen Honoraria Speaking and teaching; OrthoBio Honoraria Speaking and teaching; Fresineus Honoraria Speaking and teaching; Affymax Grant/research funds Other

Medical Editor

Anil Kumar Mandal, MD, Clinical Professor, Department of Internal Medicine, Division of Nephrology, University of Florida School of Medicine
Anil Kumar Mandal, MD is a member of the following medical societies: American College of Clinical Pharmacology, American College of Physicians, American Society of Nephrology, and Central Society for Clinical Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eleanor Lederer, MD, Consulting Staff, Louisville VA Hospital; Professor of Medicine; Interim Chief of Nephrology; Director of Nephrology Training Program; Director, Metabolic Stone Clinic; Director of Outpatient Clinics, Kidney Disease Program, University of Louisville School of Medicine
Eleanor Lederer, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Rebecca J Schmidt, DO, FACP, FASN, Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine
Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Osteopathic Internists, American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association
Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Vecihi Batuman, MD, FACP, FASN, Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System
Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology
Disclosure: Nothing to disclose.

 
 
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