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Questions and Answers
What is the main characteristic of minimal change disease on light microscopy?
What is the main characteristic of minimal change disease on light microscopy?
- Mesangial proliferation
- Glomerular hypercellularity
- Glomerular sclerosis
- Minimal changes in the glomerular structure (correct)
What is the primary mechanism of proteinuria in minimal change disease?
What is the primary mechanism of proteinuria in minimal change disease?
- Increased permeability of the glomerular capillary wall
- T-cell mediated glomerular injury
- Loss of glomerular anionic charge barrier (correct)
- Decreased glomerular filtration rate
What is the most common presentation of minimal change disease?
What is the most common presentation of minimal change disease?
- Nephritic syndrome
- Chronic kidney disease
- Nephrotic syndrome (correct)
- Acute kidney injury
What is the typical finding on immunofluorescence microscopy in minimal change disease?
What is the typical finding on immunofluorescence microscopy in minimal change disease?
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What is the characteristic finding on electron microscopy in minimal change disease?
What is the characteristic finding on electron microscopy in minimal change disease?
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What is the typical age range affected by minimal change disease?
What is the typical age range affected by minimal change disease?
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Study Notes
Minimal Change Disease
Definition
- A type of glomerulonephritis characterized by minimal changes in the glomerular structure on light microscopy
- Also known as lipoid nephrosis or nil lesion
Pathophysiology
- Immune-mediated disease, likely involving T-cell dysfunction
- Increased permeability of the glomerular capillary wall, leading to proteinuria
- Loss of glomerular anionic charge barrier, allowing albumin to pass through the glomerular filtration barrier
Clinical Features
- Most common cause of nephrotic syndrome in children (80-90%)
- Rare in adults (10-20%)
- Presents with:
- Nephrotic syndrome (proteinuria, edema, hypertension, lipiduria)
- Hematuria (microscopic or gross)
- Normal or slightly elevated serum creatinine
Diagnosis
- Renal biopsy:
- Light microscopy: normal or minimal changes
- Immunofluorescence: negative or minimal deposits
- Electron microscopy: fusion of podocyte foot processes
- Urinalysis: massive proteinuria (>3.5 g/24 hours)
- Serum albumin: low (<3 g/dL)
Treatment
- Steroids (prednisone) are the first-line therapy
- Response to steroids: 80-90% of patients achieve remission
- Relapse rate: 30-50%
- Additional immunosuppressive therapy (e.g., cyclophosphamide, mycophenolate mofetil) may be required in resistant or relapsing cases
Minimal Change Disease
Definition
- Characterized by minimal changes in glomerular structure on light microscopy
- Also known as lipoid nephrosis or nil lesion
Pathophysiology
- Immune-mediated disease involving T-cell dysfunction
- Increased permeability of glomerular capillary wall leads to proteinuria
- Loss of glomerular anionic charge barrier allows albumin to pass through glomerular filtration barrier
Clinical Features
- Most common cause of nephrotic syndrome in children (80-90%)
- Rare in adults (10-20%)
- Presents with:
- Nephrotic syndrome (proteinuria, edema, hypertension, lipiduria)
- Hematuria (microscopic or gross)
- Normal or slightly elevated serum creatinine
Diagnosis
- Renal biopsy:
- Light microscopy: normal or minimal changes
- Immunofluorescence: negative or minimal deposits
- Electron microscopy: fusion of podocyte foot processes
- Urinalysis: massive proteinuria (>3.5 g/24 hours)
- Serum albumin: low
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