Treatment of minimal change disease

The management of minimal change nephropathy involves:

• diuretics should be used with care, avoiding hyponatraemia and a further drop in intravascular volume
• salt-poor albumin is used in a few patients
• restrict fluid intake while the patient is oedematous
• prophylactic penicillin if oedematous
• 90% of children respond to steroids within 8 weeks

Immunosuppression (cyclophosphomide, ciclosporin, ritixumab) may be indicated if there are early/frequent relapses or steroid side-effects/dependence.

A remission that lasts three years is usually permanent.

With respect to interventions for minimal change disease in adults a systematic review concluded (1):

• concludes calcineurin inhibitors and mycophenolate probably make little or no difference to rate of remission, partial remission or relapse vs prednisolone, but calcineurin inhibitors may reduce adverse effects

Reference:

• Azukaitis K, Palmer SC, Strippoli GFM, Hodson EM. Interventions for minimal change disease in adults with nephrotic syndrome. Cochrane Database of Systematic Reviews 2022, Issue 3. Art. No.: CD001537. DOI: 10.1002/14651858.CD001537.pub5