[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Kidney](https://durgical.com/en/general-pathology/areas/kidney/) › Minimal change disease

# Minimal change disease

- Lesion

The commonest cause of nephrotic syndrome in children: the glomeruli look normal, but the podocytes have flattened their feet.

Updated Nov 12, 2026

## Key points

- Peak at two to six years; the leading cause of nephrotic syndrome in children.
- LM normal, IF negative, EM diffuse foot process effacement.
- Selective proteinuria: mostly albumin.
- Lipid-laden proximal tubular cells gave it the old name lipoid nephrosis.
- Secondary forms: NSAIDs, Hodgkin lymphoma and other lymphoid tumours, atopy and recent immunization or infection.

## 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.

## Memory aid

Minimal on the slide, maximal in the urine: the EM shows feet that fell flat.

## 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.

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## Elsewhere in DurgiPedia

- [Glomerulus and the filtration barrier: podocytes, mesangium, JGA](https://durgical.com/en/histology/glomerulus-and-the-filtration-barrier-podocytes-mesangium-jga/)

## Connections

## Related 4

- [Focal segmental glomerulosclerosis](https://durgical.com/en/general-pathology/focal-segmental-glomerulosclerosis/)
- [Glomerular diseases: comparison table](https://durgical.com/en/general-pathology/glomerular-diseases-comparison-table/)
- [Clinical syndromes of kidney disease](https://durgical.com/en/general-pathology/clinical-syndromes-of-kidney-disease/)
- [Hodgkin lymphoma](https://durgical.com/en/general-pathology/hodgkin-lymphoma/)

## Related conditions 3

- [Minimal change disease](https://durgical.com/en/conditions/minimal-change-disease/)
- [Nephrotic syndrome](https://durgical.com/en/conditions/nephrotic-syndrome/)
- [Hodgkin lymphoma](https://durgical.com/en/conditions/hodgkin-lymphoma/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

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](https://medlineplus.gov/ency/article/000496.htm) (MedlinePlus, US National Library of Medicine, 2025); [Nephrotic syndrome: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/000490.htm) (MedlinePlus, US National Library of Medicine, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/minimal-change-disease/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/minimal-change-disease/