Minimal Change Disease

Minimal change disease (MCD) is a disorder where there is damage to glomeruli, the tiny filtering units in the kidney that remove wastes from the blood. MCD can lead to nephrotic syndrome. As a result, large amounts of protein leaks into the urine, which in turn reduces the amount of protein in your blood, known as proteinuria. You may notice that your urine foams more than usual because of the amount of protein in it. In addition to the lost protein, fluid leaks out of the bloodstream into your tissues, which causes swelling, known as edema. The swelling may be most noticeable in your legs after you have been standing and in the tissue under your eyes when you first get up in the morning. However, it may also occur in other parts of your body and weight gain can result from any fluid retention. In addition to proteinuria and edema, other symptoms may include high blood pressure, high cholesterol, and a higher risk of blood clots.

MCD is more common in children than adults and more frequently found in boys than girls. However, it can still occur in adults.

Although the exact cause of MCD is not known, possible contributing factors may include allergic reactions, use of certain pain killers called NSAIDs, tumors and viral infections.

How is Minimal Change Disease Diagnosed?
A doctor can test your blood and urine to find out if your kidneys are functioning properly. A urine test can check for the amount of protein and other things to indicate kidney damage. A blood test for serum creatinine can be used to calculate glomerular filtration rate (GFR), which tells how well your kidneys are filtering wastes from the blood. Your blood may also be tested for high levels of cholesterol.

A biopsy may be done to confirm a diagnosis. In this test, a tiny piece of your kidney is removed with a special needle, and looked at under a microscope. The damage is not visible under a regular light microscope. It can only be seen under an electron microscope. If a kidney biopsy reveals little or no damage, then a diagnosis of MCD may be made if other symptoms, such as protein in the urine and swelling, are noticed.

How is Minimal Change Disease Treated?
The main treatment for MCD are corticosteroids (often called "steroids"), such as prednisone and prednisolone, which are given to help control the loss of protein in the urine (proteinuria). Steroids can lead to complete remission in most cases. Children with MCD generally respond better to steroids than adults, and relapses are more likely to occur in adults. Relapses can occur in the short term and if this happens more steroids may be given. If steroids do not work, your doctor may suggest other medicines that affect the immune system, such as cyclophosphamide or cyclosporine.

Your doctor may also prescribe certain medicines that are used to lower blood pressure, but may also help reduce the protein in the urine. To help with the swelling (edema), your doctor may also prescribe diuretics (water pills). Reducing dietary salt can also help control swelling.

The vast majority of children and adults recover from MCD and avoid relapses over the long term. Kidney failure is rare in patients with MCD.

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© 2015 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. Please consult a physician for specific treatment recommendations.