Minimal-Change Disease Follow-up

Updated: Dec 24, 2018
  • Author: Abeera Mansur, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
  • Print
Follow-up

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. [27]

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.

Ling et al reported that urinary levels of CD80 have prognostic value in chlidren with MCD. IIn their study of 64 children with nephrotic syndrome, progression to chronic kidney disease occurred in 2.9% of those with CD80 levels above 328.98 ng/g creatinine, compared with 41.4% of those with levels below that threshold (P < 0.001). The predicted response to immunosuppression therapy was 100% in patients with high urinary CD80 levels, versus 34.5% in those with low levels (P < 0.001). [9]

Adults have a similarly good prognosis. Survival rates of 85-90% are observed 10 years or more after disease onset. An observational study of 78 adult patients found that although 10% were steroid-resistant, 98% achieved remission by a median of 5 weeks; 61% relapsed, at a median of 11 months, and patients had a median of 2 relapses during follow-up. Risk of relapse was increased in patients with a higher estimated glomerular filtration rate, and early relapse occurred significantly more often in women. Five patients subsequently developed focal segmental glomerulosclerosis; those patients had a lower baseline creatinine, a higher serum albumin, and a longer time to remission and were more likely to have steroid-resistant disease. [28]

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