Minimal-Change Disease Clinical Presentation

Updated: Nov 13, 2020
  • Author: Abeera Mansur, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Presentation

History

Facial edema is noted first. Edema may be preceded by an upper respiratory tract infection, an allergic reaction to a bee sting, the use of certain drugs, or malignancies.

Malaise and easy fatigability can occur. Weight gain often is an additional feature.

The patient also may present with one or more of the following:

  • Hypovolemia
  • Hypertension
  • Thromboembolism
  • Infection
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Physical Examination

The blood pressure usually is normal in children [11] but may be elevated in adults. (In addition, the plasma creatinine in adults is often slightly elevated at presentation.)

Dependent edema is the most prominent sign. The retina has a wet appearance. Subungual edema with horizontal lines (called Muehrcke lines) also may occur.

Hernias may be found, and the elasticity of the ears may be decreased.

Heavy proteinuria over an extended period of time leads to a state of protein depletion with muscle wasting, thinning of the skin, and growth failure.

Pleural and ascitic fluid can accumulate. Rarely, cellulitis, peritonitis, or pneumonia may be the first indication of an underlying nephrotic syndrome.

Children may have growth failure.

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Causes

Almost all cases are idiopathic, but a small percentage of cases (approximately 10-20%) may have an identifiable cause. Secondary cases may be due to any of the following:

  • Drugs - Nonsteroidal anti-inflammatory drugs (NSAIDs), rifampin, interferon, ampicillin/penicillin, trimethadione, mercury-containing cosmetic skin cream

  • Toxins - Mercury, [12] lithium, bee stings, fire coral exposure [13]

  • Infection - Infectious mononucleosis, HIV, immunization

  • Tumor - Hodgkin lymphoma [14] (most commonly), carcinoma, other lymphoproliferative diseases

  • Hematopoietic stem cell transplantation [15]

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