Minimal change disease
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Minimal change disease
Pathology
Renal and ureteral disorders
Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis
Acute tubular necrosis
Postrenal azotemia
Prerenal azotemia
Renal azotemia
Horseshoe kidney
Potter sequence
Renal agenesis
Hypercalcemia
Hyperkalemia
Hypermagnesemia
Hypernatremia
Hyperphosphatemia
Hypocalcemia
Hypokalemia
Hypomagnesemia
Hyponatremia
Hypophosphatemia
Hydronephrosis
Kidney stones
Renal cortical necrosis
Renal papillary necrosis
Alport syndrome
Goodpasture syndrome
IgA nephropathy (NORD)
Lupus nephritis
Poststreptococcal glomerulonephritis
Rapidly progressive glomerulonephritis
Amyloidosis
Diabetic nephropathy
Focal segmental glomerulosclerosis (NORD)
Lupus nephritis
Membranoproliferative glomerulonephritis
Membranous nephropathy
Minimal change disease
Acute pyelonephritis
Chronic pyelonephritis
Medullary cystic kidney disease
Medullary sponge kidney
Multicystic dysplastic kidney
Polycystic kidney disease
Chronic kidney disease
Renal tubular acidosis
Angiomyolipoma
Beckwith-Wiedemann syndrome
Nephroblastoma (Wilms tumor)
Renal cell carcinoma
WAGR syndrome
Renal artery stenosis
Renal system pathology review
Acid-base disturbances: Pathology review
Congenital renal disorders: Pathology review
Electrolyte disturbances: Pathology review
Kidney stones: Pathology review
Nephritic syndromes: Pathology review
Nephrotic syndromes: Pathology review
Renal and urinary tract masses: Pathology review
Renal failure: Pathology review
Renal tubular acidosis: Pathology review
Renal tubular defects: Pathology review
Urinary incontinence: Pathology review
Urinary tract infections: Pathology review
Assessments
Minimal change disease
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2022
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2016
Minimal change disease p. 618, 619
Transcript
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Contributors
Minimal-change disease, sometimes called nil disease, affects the millions of the kidney’s glomeruli, which are the specific parts of the kidney where small molecules are first filtered out of blood and into the urine.
Specifically, it’s a type of nephrotic syndrome, in fact, the most common nephrotic syndrome seen in children.
But what exactly is nephrotic syndrome? Well usually the glomerulus only lets small molecules—like sodium and water—move from the blood into the kidney nephron where it eventually make its way into the urine.
But with nephrotic syndromes, the glomeruli are damaged and they become more permeable, so they start letting plasma proteins come across from the blood to the nephron and then into the urine, which causes proteinuria—typically greater than 3.5 grams per day.
An important protein in the blood is albumin, and so when it starts leaving the blood, people get hypoalbuminemia—low albumin in the blood.
With less protein in the blood the oncotic pressure falls, which lowers the overall osmotic pressure, which drives water out of the blood vessels and into the tissues, called edema.
Finally, it’s thought that as a result of either losing albumin or losing some protein or proteins that inhibit the synthesis of lipids—or fat—you get increased levels of lipids in the blood, called hyperlipidemia.
Just like the proteins, these lipids can also get into the urine, causing lipiduria.
And those are the hallmarks of nephrotic syndrome—proteinuria, hypoalbuminemia, edema, hyperlipidemia, and lipiduria.
Okay, so minimal change disease is a type of nephrotic syndrome—got it, but how exactly do those glomeruli start letting plasma proteins like albumin through?
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine" McGraw Hill Education/ Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "The Treatment of Minimal Change Disease in Adults" Journal of the American Society of Nephrology (2013)
- "Minimal Change Disease" Clinical Journal of the American Society of Nephrology (2016)
- "Management of Childhood Onset Nephrotic Syndrome" Pediatrics (2009)
- "The Treatment of Minimal Change Disease in Adults" Journal of the American Society of Nephrology (2013)
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