[1] Nephrotic syndrome leads to the loss of significant amounts of protein to the urine (proteinuria), which causes the widespread edema (soft tissue swelling) and impaired kidney function commonly experienced by those affected by the disease.

[3] The clinical signs of minimal change disease are proteinuria (abnormal excretion of proteins, mainly albumin, into the urine), edema (swelling of soft tissues as a consequence of water retention), weight gain, and hypoalbuminemia (low serum albumin).

Rather, an altered T cell-mediated immunologic response with abnormal secretion of lymphokines by T cells is thought to modify the glomerular basement membrane, specifically the podocytes, increasing permeability.

[4] Data from a longitudinal study (Nephrotic Syndrome Study Network – NEPTUNE) published in 2022 suggested that up to 29% of biopsy-confirmed, mixed pediatric and adult minimal change disease cases exhibited serum autoantibodies against nephrin, a structural protein located in the podocyte slit diaphragm.

[6] An additional multi-center study published in 2024 confirmed the presence of nephrin autoantibodies in 44% of adults and 52% of children with minimal change disease.

[7] In this study, autoantibody level correlated with disease activity, with up to 90% of patients not receiving immunosuppressive therapy testing positive for nephrin antibodies.

[4] This hypothesis is supported by recent findings of anti-nephrin antibodies isolated in minimal change disease.

This fluid collects most commonly in the feet and legs, in response to gravity, particularly in those with poorly functioning valves.

As a result of the excess fluid, individuals with minimal change disease often gain weight, as they are excreting less water in the urine, and experience fatigue.

Initial workup can include a urinalysis, kidney function tests, serum albumin level and a lipid panel.

[3] As MCD is the most common type of nephrotic syndrome in children, renal biopsy is not usually done in children under the age of 10 unless there are concerning features that are unusual for the disease (high blood pressure, bloody urine, renal dysfunction) and if they fail to respond to corticosteroid therapy.

[1] Along with corticosteroid therapy, acute symptomatic management involves salt and fluid restriction to control the swelling.

[9] Other medications such as ACE inhibitors to reduce the amount of protein in the urine or statins to decrease high levels of cholesterol seen with nephrotic syndrome are generally unnecessary.

[1] Adults with MCD tend to respond more slowly to corticosteroid treatment, taking up to 3 or 4 months, than children do.