### 날짜 : 2024-03-21 16:18 ### 주제 : Minimal change disease #medicine #공부 ---- Minimal Change Disease (MCD) is the most common cause of nephrotic syndrome in children but can also affect adults. It is characterized by minimal or no changes visible under light microscopy in the kidney tissue, hence the name. However, electron microscopy reveals effacement of the foot processes of podocytes, which are cells in the glomeruli responsible for filtering blood. ### Pathophysiology The precise cause of MCD is unknown, but it's believed to involve an abnormal immune response. This condition is thought to be primarily a T-cell disorder, where cytokines released by T-cells affect the permeability of the glomerular basement membrane, leading to significant proteinuria but with minimal changes observable under standard light microscopy. ### Clinical Presentation Patients with MCD typically present with: - Sudden onset of nephrotic syndrome, marked by heavy proteinuria, hypoalbuminemia, hyperlipidemia, and edema. - Unlike more severe forms of nephrotic syndrome, renal function in MCD usually remains normal, and hematuria (blood in the urine) is less common. - MCD can be triggered by respiratory infections, vaccinations, or allergic reactions in children. ### Diagnosis The diagnosis of MCD is largely based on clinical presentation and laboratory findings indicative of nephrotic syndrome. Confirmation often requires a kidney biopsy, especially in adults, to rule out other causes of nephrotic syndrome. The biopsy in MCD shows normal glomeruli on light microscopy but diffuse effacement of the podocyte foot processes on electron microscopy. ### Treatment The primary treatment for MCD is corticosteroids, such as prednisone, which are effective in inducing remission in the majority of patients. The response to steroids is often rapid and complete, making it both a therapeutic and diagnostic tool; a good response supports the diagnosis of MCD. - **Corticosteroids**: The initial treatment usually involves a high dose of corticosteroids for several weeks, followed by a tapering dose. Most patients respond within 4-8 weeks. - **Immunosuppressants**: For steroid-resistant cases or to minimize steroid side effects, medications like cyclophosphamide, calcineurin inhibitors (cyclosporine, tacrolimus), or rituximab may be used. - **Supportive Care**: Includes managing edema with diuretics, maintaining a balanced diet, and controlling blood pressure and cholesterol levels. ### Prognosis The prognosis for patients with MCD is generally favorable. Most children achieve complete remission with corticosteroids, and relapses, though common, are typically responsive to treatment. The disease in adults can be more resistant to treatment and prone to relapses, but the overall prognosis remains good. Continuous or repeated treatments may be necessary, and long-term monitoring is essential to manage and prevent potential complications, including those related to prolonged steroid use.