Minimal change disease
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| ICD-10 | N04. |
|---|---|
| ICD-9 | 581.3 |
| DiseasesDB | 8230 |
| MedlinePlus | 000496 |
| eMedicine | med/1483 |
Minimal change disease or nil disease (lipoid nephrosis) is a disease of the kidney which causes nephrotic syndrome and usually affects children (peak incidence at 2-3 years of age).[1]
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[edit] Symptoms
The symptoms are proteinuria (leakage of protein into the urine) and water retention. There are other kidney diseases that have these same symptoms but a needle biopsy shows change in the kidney tissue if these other diseases are present.
[edit] Causes
Minimal change disease can be associated with food allergies, medications, or hematologic malignancies, or it can occur idiopathically. The pathology does not appear to involve complement, immunoglobulins, or immune complex deposition. Rather, an altered cell-mediated immunologic response with abnormal secretion of lymphokines by T cells is thought to reduce the production of anions in the glomerular basement membrane, thereby increasing the glomerular permeability to serum albumin through a reduction of electrostatic repulsion.[2] The loss of anionic charges is also thought to favor foot process fusion. With minimal change disease the kidney tissue appears normal under a light microscope, but shows podocyte foot process effacement under an electron microscope.[1]
[edit] Treatment
Prednisone is prescribed along with a blood pressure medication, typically an ACE inhibitor such as lisinopril. Often the liver is overactive with minimal change disease and over produces cholesterol. Therefore a statin drug is often prescribed for the duration of the treatment. When the urine is clear of protein, the drugs can be discontinued. 50% of patients will relapse and need further treatment.
[edit] Other notes
80% of those who get minimal change disease have a recurrence with 20% never realizing another occurrence. Some authors have noted that other conditions associated with T-cell abnormalities, such as Hodgkin's disease and T-cell lymphoma, are sometimes associated with minimal change disease.
[edit] External links
- GPnotebook 355794967
- Kidcomm - An online resource for parents dealing with childhood kidney diseases
- National Kidney Foundation
[edit] References
- ^ a b Kumar V, Fausto N, Abbas A (editors) (2003). Robbins & Cotran Pathologic Basis of Disease, 7th, Saunders, pp. 981-2. ISBN 978-0-721-60187-8.
- ^ Mathieson P (2003). "Immune dysregulation in minimal change nephropathy". Nephrol Dial Transplant 18 Suppl 6: vi26-9. PMID 12953038.
Diseases of the glomerulus: Lupus nephritis | Post-infectious glomerulonephritis | Minimal change disease | Focal segmental glomerulosclerosis | Diabetic nephropathy | IgA nephropathy
Diseases of the proximal convoluted tubules: Fanconi syndrome (Type II renal tubular acidosis) | renal cell carcinoma
Diseases of the distal convoluted tubules: pseudohypoaldosteronism (Type IV renal tubular acidosis)
Diseases of the collecting duct: Type I renal tubular acidosis
Tumours of the kidney: renal cell carcinoma | Wilms' tumour (children)
Diseases of the renal vasculature: renal artery stenosis | vasculitis | atheroembolic disease
Tubulointerstitial diseases of the kidney: Drug-induced interstitial nephritis | Obstructive nephropathy | Radiation nephritis | Reflux nephropathy | Sarcoidosis
Genetic diseases of the kidney/syndromes associated with kidney dysfunction: Alport syndrome | Polycystic kidney disease | Wilms' tumour (children) | von Hippel-Lindau syndrome | Hereditary papillary renal carcinoma | Birt-Hogg-Dube syndrome | Hereditary renal carcinoma
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