Health Encyclopedia

Minimal change disease

Definition

Minimal change disease is a kidney disorder that can lead to nephrotic syndrome, although the nephrons of the kidney look normal under a regular microscope.

Alternative Names

Minimal change nephrotic syndrome; Nil disease; Lipoid nephrosis; Idiopathic nephrotic syndrome of childhood

Causes, incidence, and risk factors

Each kidney is made of more than a million units called nephrons, which filter blood and produce urine.

In minimal change disease, there is damage to the glomeruli -- the tiny blood vessels inside the nephron. The disease gets its name because this damage isn't visible under a regular microscope. It can only be seen under an electron microscope.

Minimal change disease is the most common cause of nephrotic syndrome in children. It is also frequently seen in adults.

The cause is unknown, but the disease may occur after:

Allergic reactions
Recent immunizations
Viral infection

Symptoms

There may be symptoms of nephrotic syndrome:

Foamy appearance of the urine
Poor appetite
Swelling (especially around the eyes, feet and ankles, and in the abdomen)
Weight gain (from fluid retention)

Minimal change disease does not reduce the amount of urine produced. It rarely progresses to kidney failure.

Signs and tests

The doctor may not be able to see any obvious outward signs of the disease, other than swelling. Blood and urine tests reveal signs typical of nephrotic syndrome, including:

High cholesterol
High levels of protein in the urine
Low levels of albumin in the blood

A kidney biopsy and examination of the tissue with an electron microscope can show signs of minimal change disease. An immunofluorescence exam of the biopsied kidney tissue is negative.

Treatment

Corticosteroids can cure minimal change disease in most children. Some patients may need to stay on steroids to keep the disease in remission.

Adults do not respond to steroids quite as well as children, but many still do find steroids effective. Adults may have more frequent relapses and steroid dependence.

Frequent relapsers (more than three relapses) may need cytotoxic therapy. In most cases, this involves a course of cyclophosphamide. Other medicines that have been used include cyclosporine and chlorambucil.

Swelling may be treated with:

ACE inhibitor medicines
Blood pressure control
Diuretics (water pills)

You may receive instructions on how much salt to allow in your diet.

Expectations (prognosis)

Minimal change disease usually responds well to corticosteroids, often within the first month. A relapse can occur, but patients may improve after prolonged treatment with corticosteroids and medications that suppress the immune system (immunosuppressive medications).

Complications

Nephrotic syndrome
Side effects of medications

Calling your health care provider

Call for an appointment with your health care provider if you develop symptoms of minimal change disease.

If you have this disorder, call for an appointment with your health care provider if your symptoms worsen or you develop new symptoms, including side effects from the medications used to treat the disorder.

Prevention

There is no known prevention.

References

Brenner BM. Brenner and Rector's The Kidney. 7th ed. Philadelphia, Pa: Saunders; 2003.

Review Date:11/12/2007
Reviewed By:Charles Silberberg, D.O., Private Practice specializing in Nephrology, Affiliated with NY Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network.

ADAM Quality A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.