Minimal-Change Disease Treatment & Management

  • Author: Abeera Mansur, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN   more...
 
Updated: Aug 8, 2011
 

Medical Care

Corticosteroids are the treatment of choice, leading to complete remission of proteinuria in most cases. Approximately 90% of children respond within 2 weeks to prednisone at a dose of 60 mg/msq/d. The treatment is continued for another 6 weeks, at lower doses of prednisone, after the remission of proteinuria. In some children, proteinuria fails to clear by 6-8 weeks, and performing a renal biopsy may be useful to determine if another process may be present.

Adults respond more slowly than children. A response in up to 80-90% has been recorded in adolescents and adults. However, the time to remission is up to 16 weeks. If patients are steroid-resistant or they relapse frequently, a trial of immunosuppressants is given.

MCD secondary to Hodgkin lymphoma is frequently resistant to steroids and will remit with cure of the primary disease.

Angiotensin converting enzyme inhibitors and angiotensin II receptor blockers, alone or in combination should be used with a goal of reducing the proteinuria. Blood pressure and renal function should be monitored closely in patients on angiotensin converting enzyme inhibitors and angiotensin II receptor blockers.

  • Hypovolemia
    • This necessitates immediate volume expansion with purified plasma protein fraction and isotonic sodium chloride solution.
    • The administration of parenteral albumin infusion is not appropriate long-term management for patients with hypoalbuminemia because it has only a transient effect. Such crises should be avoided with recognition of the earlier signs of hypovolemia, including abdominal pain, increase in hematocrit, and response to contributing factors (eg, diarrhea, septicemia, diuretic therapy).
  • Edema
    • This condition should be controlled by dietary sodium restriction.
    • Small amounts of edema are not of much clinical significance.
    • The use of diuretics should be reserved for patients with severe cases of edema, particularly in the presence of respiratory or gastrointestinal symptoms, and when the condition restricts activity.
  • Thrombotic episodes should be prevented by mobilization and meticulous attention to venipuncture and intravenous infusion sites. Established episodes should be managed with heparinization.
  • Infections
    • These must be treated aggressively.
    • Cellulitis, peritonitis, otitis, and pneumonia are common infections.
    • Susceptibility to pneumococcal infections warrants the administration of penicillin prophylaxis to patients in relapse; corticosteroids increase the problem of infection.
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Consultations

  • Consultation with a nephrologist generally is needed. The nephrologist has the expertise to perform and interpret the renal biopsy.
  • A renal pathologist has the expertise to interpret biopsy findings under light microscopy, immunofluorescence, and electron microscopy.
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Diet

  • An adequate dietary protein intake, in accordance with the recommended daily allowance (RDA) is necessary. No evidence suggests that hepatic albumin synthesis is elevated with protein intake that is higher than the RDA.
  • Dietary sodium restriction helps forestall the progression of edema and also is prudent in the management of hypertension.
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Activity

  • Mobilization, rather than bed rest, is indicated to avoid thromboembolic complications.
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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; Gambro None None; Genzyme None; Genzyme Consulting fee None; Reata Grant/research funds None; Boehringer Ingelheim Honoraria None

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

Eleanor Lederer, MD  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 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: Dept of Veterans Affairs Grant/research funds Research

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 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: Renal Ventures Ownership interest Other

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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