How does your body get rid of waste? The answer lies in the excretory system. Kidneys are the major organs responsible for flushing out toxins from the body. It also removes acid produced by body cells to maintain a perfect balance of minerals, salt, and water. A kidney comprises several nephrons, each with a glomerulus that filters the blood and a tubule that adds the required substances to the blood. The rest becomes urine and is passed out of the body. When these glomeruli are damaged for whatever reason, proteins from the blood escape through the urine. This condition is known as minimal change disease. Though it can affect anyone, it is one of the most common idiopathic nephrotic syndromes (a nephrotic syndrome that occurs when there is no identifiable reason) in children. According to a study published in 2007, minimal change disease can affect 70–90% of children who are suffering from nephrotic syndrome and are older than 12 months. In contrast, only 10–15 percent of adults with nephrotic syndrome are affected by it. It is said that the glomeruli of these patients usually look normal under a regular microscope and need high magnification for examination.
Causes of Minimal Change Disease
Most patients with minimal change nephrotic syndrome are children, and the exact cause is unknown. But there are some secondary causes, including
- Allergic reactions due to dust, pollens, fungi, pet fur, bee stings, etc.
- Viral infections like mycoplasma, hepatitis C, tuberculosis, etc.
- Consumption of certain medications, including antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs)
- Existing glomerular diseases such as Berger’s disease that can further lead to multiple ailments.
- Abnormal growth of tissues due to tumours or cancer conditions like leukaemia.
- In rare cases, vaccinations against flu and pneumococcal
Symptoms of Minimal Change Disease
- Excess leakage of proteins in urine that makes it foamy (proteinuria)
- Excessive fluid retention and sudden weight gain
- Presence of high levels of creatinine (a type of toxin) in the blood
- Experiencing swelling, especially around the ankles, abdomen, hands, and eyes (oedema)
- Protein deficiency in the blood (hypoalbuminemia)
- Increased levels of lipids and fats in the blood (hyperlipidemia)
- A sudden rise in the blood pressure
- Nephrotic syndrome, which means experiencing all the above-stated symptoms together, can trigger kidney health problems.
Treatment Options Available to Cure Minimal Change Disease
The causes of MCD are different in different age groups. Hence, the treatment plan for this glomerular disease may differ for children and adults. Moreover, it varies according to the response of the patient’s body. General healthcare advice to all MCD patients is to restrict sodium in the diet to reduce the symptoms.
The treatment plan for children
It refers to the use of a steroid that is categorised as a corticosteroid. It helps reduce the occurrence of symptoms and inflammation in the kidneys. Moreover, it helps in alleviating the symptoms of proteinuria. After the remission of proteinuria, the dosage of these steroids is reduced. According to the statistics published on Medscape, 90% of children positively respond to prednisone (corticosteroid) within two weeks. One must keep in mind that the patient should consider full therapy. A sudden pause can lead to a relapse.
Some children don’t respond to steroid therapy. It means they suffer from steroid-resistant nephrotic syndrome (SRNS) and need a combination of different medicines. It can be a combination of oral cytotoxic drugs, angiotensin-converting enzyme (ACE) inhibitors (for blood pressure), azathioprine, and mycophenolate mofetil. The current condition and other health issues determine the precise combination. Thus, the doctor may recommend going for a biopsy.
The Treatment Plan for Adults
The treatment starts with traditional treatment options, i.e., steroid therapy (with corticosteroids). The treatment duration in adults is longer. To avoid relapsing symptoms, one should complete the entire treatment plan. Women who want to conceive in the future should discuss this matter before the commencement of the treatment. The doctor may also prescribe various other medications, including
- ACE (Angiotensin-converting enzyme) inhibitors or ARB (Angiotensin receptor blockers) medicines (to control blood pressure)
- Diuretics, also known as water pills (to help flush excessive salt and water via the urine)
The Treatment Plan for Patients who Experience Frequent Relapse
In such a scenario, medical experts suggest the following medications:
- Cyclophosphamide (for 8–12 weeks) after achieving remission with steroids. It has potential risks of gonadal toxicity, alopecia, and bone marrow suppression.
- Cyclosporine (for 1-2 years) has a potential risk of causing hirsutism, nephrotoxicity, hypertension, and gingival hyperplasia.
- If the above medications don’t work, your doctor may recommend other drugs like mycophenolate mofetil (MMF) and rituximab (chimeric monoclonal antibody).
You can also get in touch with the expert doctors at Narayana Healthcare based in your city to get immediate attention and medical support.
When to Consult a Doctor
You can also get in touch with the expert Nephrology doctors at Narayana Healthcare based in your city to get immediate attention and medical support during injuries, health disorders or any other health concern.
- Best nephrologists in Delhi
- Best nephrologists in Bangalore
- Best nephrologists in Ahmedabad
- Best nephrologists in Gurugram
- Best nephrologists in Jaipur
Knowing causes, symptoms, and treatment options and understanding Minimal Change Disease help to take preventive action or seek immediate medical attention.
Q. What are the treatment options for minimal change disease?
A. The treatment option is primarily based on a combination of medications, which include:
- Corticosteroids can help alleviate the symptoms of proteinuria and inflammation.
- ACE inhibitors regulate blood pressure and increase hormone secretion, which can help reduce protein levels in the urine.
- Diuretics for eliminating excessive salts and water from the body.
- Other medications depend on the cause of MCD.
Q. What is the first line treatment for minimal change disease?
A. In every case, the first-line treatment for MCD is steroids for a couple of weeks (in children) or a couple of months (in adults) to achieve remission of proteinuria. Later on, the treatment roadmap depends on how the patient’s body responds to the treatment.
Q. What is minimal change disease?
A. It is a kidney disorder wherein the glomeruli get damaged, and essential nutrients, including proteins, get slipped through the urine. As a result, your body gets deprived of proteins. If left untreated, it can lead to complications like hypovolemia, acute kidney injury, venous thromboembolism, hyperlipidemia, and infections.
Q. What is the treatment for minimal change disease in adults?
A. Initially, the treatment plan for MCD in adults starts with glucocorticoid monotherapy. According to the body’s response, the dosage or medication changes. Once we achieve 80–95% remission, the dosage is reduced. The doctor suggests alternative therapy if there is a relapse or non-respondence to the treatment.
Q. How is minimal change diagnosed?
A. To determine the cause and severity of the health condition, your doctor may suggest you undergo the following diagnostic test:
- Urine test to find the levels of blood and proteins in urine.
- Blood tests to find cholesterol, toxins, and protein levels in the blood
- Glomerular filtration rate (GFR) test to know how well the kidney is filtering waste from the blood
- Kidney biopsy to find abnormalities in the cells
Q. What drugs cause a minimal change disease?
A. Many antibiotics and NSAIDs can lead to MCD. Moreover, according to a study , long-term consumption of analgesic aspirin can also result in MCD.