Study of adult minimal change disease with special emphasis on electron microscopy

Minimal change disease (MCD) is defined when nephrotic syndrome occurs without any glomerular lesions on light microscopy, negative staining on immunofluorescence microscopy, and foot process effacement but no electron dense deposits on electron microscopy. Corticosteroid-sensitive nephrotic syndrome is the term used to describe the disease occurring in children with nephrotic syndrome who respond to corticosteroids but who have not had a renal biopsy to provide the histologic proof of MCD. However, most adult patients with the nephrotic syndrome are biopsied. Attempt has been made to concentrate on electron microscopy appearances in minimal change disease in adults.

Aim is to analyse the clinical, biochemical profile of adult patients with primary NS due to minimal change disease and to study the course of the minimal change disease and to study the response to therapy and outcome of minimal change disease.

The present study evaluated 30 patients diagnosed to have adult minimal change disease admitted to Gandhi Hospital, secunderabad, during the period of December 2013 to December 2015. Patients admitted with edema were evaluated with 24 hrs urinary protein, serum albumin and lipid profile. If patient is found to have proteinuria, hypercholesterolemia and hypoalbuminemia, he/she was subjected to renal biopsy, and all biopsy proven MCD cases were include in the study group Minimal change disease was found to be common in <30 yrs age group. Major clinical manifestation is oedema.Majority of cases are steroid responsive and frequent relapses are not uncommon among adults. Microscopic hematuria, hypertension and acute kidney injury are more common in adults. Hypertension is not uncommon in adult MCD. Duration of response to steroid is longer among adult MCD In steroid resistant cases, mild mesangial hypercellularity along with foot process effacement is most common in electron microscopy finding.