Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Minimal-Change Disease Follow-up

  • Author: Abeera Mansur, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
 
Updated: Jan 26, 2015
 

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
Next

Complications

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.[20]

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.

Previous
Next

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.

Previous
Next

Patient Education

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
Previous
 
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, American Society of Nephrology

Disclosure: Nothing to disclose.

Coauthor(s)

Susie Lew, MD Professor of Medicine, Department of Medicine, Division of Renal Diseases and Hypertension, George Washington Unversity School of Medicine and Health Sciences; Medical Director, Peritoneal Dialysis Unit, George Washington University Medical Center, Gambro Healthcare/DaVita

Susie Lew, MD is a member of the following medical societies: American College of Physicians, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation

Disclosure: Received grant/research funds from Amgen for investigator; Received consulting fee from Gambro for consulting; Received grant/research funds from Questcor for investigator; Received grant/research funds from Bristol Meyers Squibb for investigator; Received grant/research funds from CMS for investigator.

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, American Society of Nephrology

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eleanor Lederer, MD, FASN Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD, FASN is a member of the following medical societies: American Association for the Advancement of Science, International Society of Nephrology, American Society for Biochemistry and Molecular Biology, American Federation for Medical Research, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, Kentucky Medical Association, National Kidney Foundation, Phi Beta Kappa

Disclosure: Received grant/research funds from Dept of Veterans Affairs for research; Received salary from American Society of Nephrology for asn council position; Received salary from University of Louisville for employment; Received salary from University of Louisville Physicians for employment; Received contract payment from American Physician Institute for Advanced Professional Studies, LLC for independent contractor; Received contract payment from Healthcare Quality Strategies, Inc for independent cont.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, 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, International Society of Nephrology

Disclosure: Nothing to disclose.

Additional Contributors

Anil Kumar Mandal, MD Clinical Professor, Department of Internal Medicine, Division of Nephrology, University of Florida College 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, Central Society for Clinical and Translational Research

Disclosure: Nothing to disclose.

References
  1. Shao YN, Chen YC, Jenq CC, et al. Serum immunoglobulin E can predict minimal change disease before renal biopsy. Am J Med Sci. 2009 Oct. 338(4):264-7. [Medline].

  2. Lai KW, Wei CL, Tan LK, et al. Overexpression of interleukin-13 induces minimal-change-like nephropathy in rats. J Am Soc Nephrol. 2007 May. 18(5):1476-85. [Medline].

  3. Izzedine H, Brocheriou I, Eymard B, et al. Loss of podocyte dysferlin expression is associated with minimal change nephropathy. Am J Kidney Dis. 2006 Jul. 48(1):143-50. [Medline].

  4. Garin EH, Mu W, Arthur JM, Rivard CJ, Araya CE, Shimada M, et al. Urinary CD80 is elevated in minimal change disease but not in focal segmental glomerulosclerosis. Kidney Int. 2010 Aug. 78(3):296-302.

  5. Ling C, Liu X, Shen Y, Chen Z, Fan J, Jiang Y, et al. Urinary CD80 levels as a diagnostic biomarker of minimal change disease. Pediatr Nephrol. 2015 Feb. 30(2):309-16. [Medline].

  6. Kontchou LM, Liccioli G, Pela I. Blood pressure in children with minimal change nephrotic syndrome during oedema and after steroid therapy: the influence of familial essential hypertension. Kidney Blood Press Res. 2009. 32(4):258-62. [Medline].

  7. Hamasaki Y, Yoshikawa N, Hattori S, et al. Cyclosporine and steroid therapy in children with steroid-resistant nephrotic syndrome. Pediatr Nephrol. 2009 Nov. 24(11):2177-85. [Medline].

  8. Swartz SJ, Eldin KW, Hicks MJ, Feig DI. Minimal change disease with IgM+ immunofluorescence: a subtype of nephrotic syndrome. Pediatr Nephrol. 2009 Jun. 24(6):1187-92. [Medline].

  9. Cattran DC, Alexopoulos E, Heering P, et al. Cyclosporin in idiopathic glomerular disease associated with the nephrotic syndrome : workshop recommendations. Kidney Int. 2007 Dec. 72(12):1429-47. [Medline].

  10. Sellier-Leclerc AL, Macher MA, Loirat C, Guerin V, Watier H, Peuchmaur M. Rituximab efficiency in children with steroid-dependent nephrotic syndrome. Pediatr Nephrol. 2010 Jun. 25(6):1109-15. [Medline].

  11. Hoxha E, Stahl RA, Harendza S. Rituximab in adult patients with immunosuppressive-dependent minimal change disease. Clin Nephrol. 2011 Aug. 76(2):151-8. [Medline].

  12. Munyentwali H, Bouachi K, Audard V, Remy P, Lang P, Mojaat R. Rituximab is an efficient and safe treatment in adults with steroid-dependent minimal change disease. Kidney Int. 2013 Jan 16. [Medline].

  13. Caridi G, Gigante M, Ravani P, et al. Clinical features and long-term outcome of nephrotic syndrome associated with heterozygous NPHS1 and NPHS2 mutations. Clin J Am Soc Nephrol. 2009 Jun. 4(6):1065-72. [Medline]. [Full Text].

  14. Li X, Li H, Chen J, et al. Tacrolimus as a steroid-sparing agent for adults with steroid-dependent minimal change nephrotic syndrome. Nephrol Dial Transplant. 2008 Jun. 23(6):1919-25. [Medline].

  15. Sinha MD, MacLeod R, Rigby E, Clark AG. Treatment of severe steroid-dependent nephrotic syndrome (SDNS) in children with tacrolimus. Nephrol Dial Transplant. 2006 Jul. 21(7):1848-54. [Medline].

  16. Westhoff TH, Schmidt S, Zidek W, Beige J, van der Giet M. Tacrolimus in steroid-resistant and steroid-dependent nephrotic syndrome. Clin Nephrol. 2006 Jun. 65(6):393-400. [Medline].

  17. Gulati A, Sinha A, Gupta A, Kanitkar M, Sreenivas V, Sharma J. Treatment with tacrolimus and prednisolone is preferable to intravenous cyclophosphamide as the initial therapy for children with steroid-resistant nephrotic syndrome. Kidney Int. 2012 Nov. 82(10):1130-5. [Medline].

  18. Fujinaga S, Hirano D, Nishizaki N, Kamei K, Ito S, Ohtomo Y, et al. Single infusion of rituximab for persistent steroid-dependent minimal-change nephrotic syndrome after long-term cyclosporine. Pediatr Nephrol. 2010. 25(3:359.

  19. Guitard J, Hebral AL, Fakhouri F, Joly D, Daugas E, Rivalan J, et al. Rituximab for minimal-change nephrotic syndrome in adulthood: predictive factors for response, long-term outcomes and tolerance. Nephrol Dial Transplant. 2014 Nov. 29(11):2084-91. [Medline].

  20. Waldman M, Crew RJ, Valeri A, et al. Adult minimal-change disease: clinical characteristics, treatment, and outcomes. Clin J Am Soc Nephrol. 2007 May. 2(3):445-53. [Medline].

  21. Ahmad H, Tejani A. Predictive value of repeat renal biopsies in children with nephrotic syndrome. Nephron. 2000 Apr. 84(4):342-6. [Medline].

  22. Araya CE, Wasserfall CH, Brusko TM, et al. A case of unfulfilled expectations. Cytokines in idiopathic minimal lesion nephrotic syndrome. Pediatr Nephrol. 2006 May. 21(5):603-10. [Medline].

  23. Audard V, Larousserie F, Grimbert P, et al. Minimal change nephrotic syndrome and classical Hodgkin's lymphoma: report of 21 cases and review of the literature. Kidney Int. 2006 Jun. 69(12):2251-60. [Medline].

  24. Bagga A, Hari P, Moudgil A, Jordan SC. Mycophenolate mofetil and prednisolone therapy in children with steroid-dependent nephrotic syndrome. Am J Kidney Dis. 2003 Dec. 42(6):1114-20. [Medline].

  25. Bonilla-Felix M, Parra C, Dajani T, et al. Changing patterns in the histopathology of idiopathic nephrotic syndrome in children. Kidney Int. 1999 May. 55(5):1885-90. [Medline].

  26. Cho BS, Yoon SR, Jang JY, Pyun KH, Lee CE. Up-regulation of interleukin-4 and CD23/FcepsilonRII in minimal change nephrotic syndrome. Pediatr Nephrol. 1999 Apr. 13(3):199-204. [Medline].

  27. Choi MJ, Eustace JA, Gimenez LF, et al. Mycophenolate mofetil treatment for primary glomerular diseases. Kidney Int. 2002 Mar. 61(3):1098-114. [Medline].

  28. Day CJ, Cockwell P, Lipkin GW, Savage CO, Howie AJ, Adu D. Mycophenolate mofetil in the treatment of resistant idiopathic nephrotic syndrome. Nephrol Dial Transplant. 2002 Nov. 17(11):2011-3. [Medline].

  29. Dijkman HB, Wetzels JF, Gemmink JH, Baede J, Levtchenko EN, Steenbergen EJ. Glomerular involution in children with frequently relapsing minimal change nephrotic syndrome: an unrecognized form of glomerulosclerosis?. Kidney Int. 2007 Jan. 71(1):44-52. [Medline].

  30. Donia AF, Gazareen SH, Ahmed HA, et al. Pulse cyclophosphamide inadequately suppresses reoccurrence of minimal change nephrotic syndrome in corticoid-dependent children. Nephrol Dial Transplant. 2003 Oct. 18(10):2054-8. [Medline].

  31. Grimbert P, Audard V, Remy P, Lang P, Sahali D. Recent approaches to the pathogenesis of minimal-change nephrotic syndrome. Nephrol Dial Transplant. 2003 Feb. 18(2):245-8. [Medline].

  32. Humphreys BD, Vanguri VK, Henderson J, Antin JH. Minimal-change nephrotic syndrome in a hematopoietic stem-cell transplant recipient. Nat Clin Pract Nephrol. 2006 Sep. 2(9):535-9; quiz 540. [Medline].

  33. Jennette JC, Falk RJ. Adult minimal change glomerulopathy with acute renal failure. Am J Kidney Dis. 1990 Nov. 16(5):432-7. [Medline].

  34. Kyrieleis HA, Lowik MM, Pronk I, et al. Long-term outcome of biopsy-proven, frequently relapsing minimal-change nephrotic syndrome in children. Clin J Am Soc Nephrol. 2009 Oct. 4(10):1593-600. [Medline]. [Full Text].

  35. Lahdenkari AT, Kestila M, Holmberg C, Koskimies O, Jalanko H. Nephrin gene (NPHS1) in patients with minimal change nephrotic syndrome (MCNS). Kidney Int. 2004 May. 65(5):1856-63. [Medline].

  36. Matsumoto K, Kanmatsuse K. Increased IL-12 release by monocytes in nephrotic patients. Clin Exp Immunol. 1999 Aug. 117(2):361-7. [Medline]. [Full Text].

  37. Nakayama M, Katafuchi R, Yanase T, Ikeda K, Tanaka H, Fujimi S. Steroid responsiveness and frequency of relapse in adult-onset minimal change nephrotic syndrome. Am J Kidney Dis. 2002 Mar. 39(3):503-12. [Medline].

  38. Niaudet P. Treatment of childhood steroid-resistant idiopathic nephrosis with a combination of cyclosporine and prednisone. French Society of Pediatric Nephrology. J Pediatr. 1994 Dec. 125(6 Pt 1):981-6. [Medline].

  39. Nolasco F, Cameron JS, Heywood EF, Hicks J, Ogg C, Williams DG. Adult-onset minimal change nephrotic syndrome: a long-term follow-up. Kidney Int. 1986 Jun. 29(6):1215-23. [Medline].

  40. Prasad GV, Vincent L, Hamilton R, Lim K. Minimal change disease in association with fire coral (Millepora species) exposure. Am J Kidney Dis. 2006 Jan. 47(1):e15-6. [Medline].

  41. Smith JD, Hayslett JP. Reversible renal failure in the nephrotic syndrome. Am J Kidney Dis. 1992 Mar. 19(3):201-13. [Medline].

  42. Tang HL, Chu KH, Mak YF, et al. Minimal change disease following exposure to mercury-containing skin lightening cream. Hong Kong Med J. 2006 Aug. 12(4):316-8. [Medline].

  43. Tarshish P, Tobin JN, Bernstein J, Edelmann CM Jr. Prognostic significance of the early course of minimal change nephrotic syndrome: report of the International Study of Kidney Disease in Children. J Am Soc Nephrol. 1997 May. 8(5):769-76. [Medline].

  44. The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. A report of the International Study of Kidney Disease in Children. J Pediatr. 1981 Apr. 98(4):561-4. [Medline].

  45. Wei CL, Cheung W, Heng CK, et al. Interleukin-13 genetic polymorphisms in Singapore Chinese children correlate with long-term outcome of minimal-change disease. Nephrol Dial Transplant. 2005 Apr. 20(4):728-34. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.