Minimal-change disease in adolescents and adults: epidemiology and therapeutic response

Abstract

BackgroundEpidemiology of minimal-change disease (MCD) in adults differs from that in children and is not studied well in Indian population.MethodsWe retrospectively studied the records of 61 adult patients with MCD to assess clinical, laboratory and histopathological features, and to evaluate the response to treatment, course and complications of the disease and therapy.ResultsThe male to female ratio was 1.17:1. Mean age was 30.46 years. Of the total, 6.55% had hypertension; 13.11% had microhaematuria. After initial treatment with steroids, 68.85% had complete remission (CR) and 13.1% had partial remission (PR). Twelve of 14 (85.71%) steroid-resistant cases had CR or PR after alternative immunosuppression with cyclophosphamide, or mycophenolate mofetil. Of all patients, 44.2% had at least one relapse; 8.19% were frequently relapsing and 26.22% were steroid dependent. After a mean follow-up of 149.9 weeks, 38 (61.29%) patients were in CR and 16 (26.22%) in PR with a mean proteinuria of 1.28 g/day, 3 being treated for relapse. Mean serum creatinine was 89.28 μmol/L (1.01 mg/dL). Fourteen (22.95%) had acute kidney injury (AKI). All but two recovered completely.ConclusionsThis single-centre study with a medium-term follow-up shows that majority of patients respond to steroids or alternative immunosuppressants. AKI is common and may not be completely reversible in some cases.

Wnt4 is a novel biomarker for the early detection of kidney tubular injury after ischemia/reperfusion injury

“…In addition, histopathological criteria are difficult to apply to the diagnosis of AKI in patients in whom kidney biopsy is usually considered to carry an inappropriate risk-to-benefit ratio. AKI is a common complication of MCD patients28, and of all the biopsy-proven patients, we found that some MCD patients displayed tubular injury without a corresponding increase in serum creatinine. Van Timmeren et al 29.…”

Predictors of Relapse in Adult-Onset Nephrotic Minimal Change Disease

“…Compared to pediatric MCD, adult-onset nephrotic MCD has been studied less extensively in terms of clinical features, treatment options and adequate durations, and relapse. Previous studies on adult-onset MCD patients have reported a higher risk of acute kidney injury 3 – 5 and delayed response to treatment with CS compared to pediatric MCD patients. 6 , 7 Although most previous studies have shown that 60% to 90% of adults with MCD achieve complete remission (CR) with CS alone, 4 – 6 , 8 – 10 a recent study showed that only 30% of adult Chinese MCD patients achieved CR after initial treatment.…”

Renal complications of hematopoietic stem cell transplantation: Report of a case and review of the literature

“…Nephrotic syndrome was associated with reversible AKI in our patient, a complication most commonly reported in MCD (especially in adults). [ 11 14 ] AKI in this setting was previously attributed to anasarca-associated renal interstitial edema but is now believed to be due to ischemic tubular injury. [ 11 14 ] MCD typically resolves without residual proteinuria or renal dysfunction.…”

“…[ 11 14 ] AKI in this setting was previously attributed to anasarca-associated renal interstitial edema but is now believed to be due to ischemic tubular injury. [ 11 14 ] MCD typically resolves without residual proteinuria or renal dysfunction. Persistence of CKD and minimal albuminuria in our patient was due to chronic CNI-nephrotoxicity, which may not be reversible even after discontinuation of CNI.…”