Minimal-Change Disease Follow-up
- Author: Abeera Mansur, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN more...
Further Outpatient Care
MCD is treated in the outpatient setting. Followup care includes the following:
Carefully monitor medication doses and adverse effects
Monitor vital signs for possible onset of hypertension
Monitor volume status
Monitor for signs of infection
The most common complications are 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.
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.
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 in MCD includes the following:
Explain the consequences of not receiving treatment for MCD
Explain to the family that children with MCD initially are treated without a tissue diagnosis
Explain the possible adverse effects of therapy, including growth retardation in children receiving long-term corticosteroids
Explain that not all patients receiving treatment respond to conventional therapies
Advise family members to 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
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