Adult Minimal Change Disease: Clinical Characteristics, Treatment and Outcomes

Adult Minimal Change Disease: Clinical Characteristics, Treatment and Outcomes

Minimal change disease (MCD) represents the third cause of nephrotic syndrome in adults. Steroids continue to be the first-line treatment for this disease in both adults and children. In the former, there is a higher percentage of acute kidney injury (AKI) at the onset and a slower response to first-line treatment requiring longer use of steroids. Risks arising from prolonged nephrotic syndrome make early treatment necessary. In this cohort, data on eighteen patients with a histopathological diagnosis of MCD are described with the aim of reporting results over one year of follow-up.

Of the 235 kidney biopsies in our registry, 18 patients were included as positive for MCD. Epidemiological data, clinical presentation, renal function at time of diagnosis, urinary sediment and treatment were included. Partial and complete remission, steroid sensitivity, steroid dependence and steroid resistance were evaluated. Relevant parameters such as albumin, creatinine, glomerular filtration rate and proteinuria were analyzed. Data were recorded at the beginning of treatment and at three, six and twelve months. An analysis of the histopathological samples was carried out.

The 18 patients were distributed as 9 male and 9 female with a median age of 27. On admission, 94% were normotensive, 88% had edema, 5% presented isolated proteinuria, 72% met criteria for nephrotic syndrome and 22% for nephrotic and nephritic syndrome. Acute kidney injury was observed in the majority of patients. Ten patients presented leukocyturia and 12 presented microscopic hematuria, granular cylinders were observed in 4 patients and hyaline cylinders in 2. Two patients required hemodialysis. Response rates were evaluated in 14 patients. The remaining 4 continued follow-up in their city of origin or abandoned it. Complete remission with steroids was achieved in 55% of patients and steroid resistance was observed in 14.2%. Steroid dependence was observed in 16% of patients.

Presentation patterns of MCD in adults are similar to those reported worldwide. Most patients presented nephrotic syndrome, acute renal injury and microscopic hematuria. Two patients required hemodialysis during the onset of the disease. Steroid treatment continues to be an effective first-line treatment.