Minimal Change Disease

• What is minimal change Disease?

  In the kidneys, the filters (glomeruli) are responsible for cleaning the blood by filtering out waste while keeping essential substances in our blood, such as proteins. In minimal change disease, the filters don’t function well because their structure is altered. As blood flows through the altered filters, large amounts of proteins can leak into the urine. The disease gets its name as the damage to the little filters cannot be seen under a regular microscope.

  
  

• Who is at risk for Minimal Change Disease?

  Children are most at risk for developing minimal change disease. Adults may develop minimal change disease as well, but this is less common.

  
  

• What are the signs and symptoms of Minimal Change Disease?

  The cause of minimal change disease is unclear. It may occur due to problems in the immune system, especially in children. In adults, there may be a secondary cause, such as tumors (like lymphoma), viral infections, allergies, and anti-inflammatory drug use. 

  Signs and symptoms of minimal change disease may include:

  • Foamy urine due to protein present in urine 

  • Swelling (edema) throughout the body, including legs and face 

  • Weight gain due to excess fluid in the body 

  • High blood cholesterol 

• What tests will my doctor perform to diagnose Minimal Change Disease?

  Your doctor will perform blood and urine tests initially. If you are an adult, your doctor will likely recommend a kidney biopsy. A kidney biopsy is a procedure where a doctor takes a sample of kidney tissue using a needle and studies the sample under a microscope.

  
  

• Treatment of Minimal Change Disease

  For both children and adults, the main treatment option is immune supression. Based on treatment response or disease recurrence, the use of each treatment option may vary. It is crucial to take these medications as prescribed and not stop them suddenly. Unfortunately, medications that suppress the immune system can often have several side effects, and often your doctor may prescribe some additional medicines to prevent some of the side effects. But in overwhelming majority of cases, the benefit of preserving the kidneys outweigh the risks associated with the medications. 

   If you fail to respond to the initial therapy, your doctor will discuss alternative treatment options with you. 

  Other treatments that are used in addition to medications that suppress the immune system may be used to manage the symptoms of the disease. These typically include: 

  • Medications that reduce blood pressure and reduce protein leakage.

  • Diuretics (water pills) that are used to reduce swelling throughout the body.

  • Cholesterol-lowering pills if your cholesterol level is very high. 

  • You may be advised to reduce your water and salt intake to reduce swelling.  

  Regular follow-up with your doctor is critical to ensure that you are responding well to treatment and not developing side effects.   

  
  

• Will I develop kidney failure if I have Minimal Change Disease? Will I need dialysis? Will I need a kidney transplant?

  Kidney failure is rare, with minimal change in disease. Most patients respond well to first-line treatment. Relapses can occur over the long term, usually treated with a different medication. If you have many relapses, your doctor may discuss alternate therapies. 

Authors: 

Vineel Kumar, Touro University - California, US

Victoria Vera, University of California, Berkeley - California, USA