Minimal change disease
- Lesion
The commonest cause of nephrotic syndrome in children: the glomeruli look normal, but the podocytes have flattened their feet.
What it is
Minimal change disease is a diffuse podocytopathy in which the only visible lesion is effacement of foot processes on electron microscopy. A circulating factor, probably linked to T cells, and in some patients antibodies against nephrin, disturb the slit diaphragm. It responds well to corticosteroids and leaves the kidney intact, although relapses are common.
Structure
- Glomeruli look normal by light microscopy.
- Proximal tubular cells are full of lipid and protein droplets from reabsorbed filtrate.
- Electron microscopy: foot processes flattened along the whole capillary, cytoplasmic vacuoles and microvilli in podocytes; no deposits.
Step by step
- An immune trigger (infection, allergy, lymphoma) alters T-cell signals.
- A circulating factor or anti-nephrin antibodies reach the podocytes.
- The slit diaphragm loosens and foot processes retract and flatten.
- Albumin passes the barrier: selective proteinuria, hypoalbuminemia and edema.
- Corticosteroids restore the podocytes; the foot processes reform without scarring.
Clinical notes
- A preschool child with puffy eyes in the morning, then generalized edema, and normal blood pressure and renal function.
- Children with steroid-responsive nephrotic syndrome are often treated without biopsy.
- Risks of the nephrotic state: infections (peritonitis), thrombosis and hyperlipidemia.
Test yourself
Think of the answer, then tap the question to see it.
What is the only structural lesion in minimal change disease?
Diffuse effacement of podocyte foot processes, seen by electron microscopy.
What does selective proteinuria mean?
The urine protein is mainly albumin, with little of the larger globulins.
Which lymphoma is associated with minimal change disease?
Hodgkin lymphoma.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Minimal change disease: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2025); Nephrotic syndrome: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2025).
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Representative model, for educational purposes only.