What is mild glomerular disease?
Minimal Change Disease (MCD) is a common primary glomerular disease, mostly seen in children and adolescents, and is one of the main causes of nephrotic syndrome. It is characterized by that the structure of glomeruli is basically normal under a light microscope, but extensive fusion of podocyte foot processes can be seen under an electron microscope. The following is a detailed analysis of the disease.
1. Overview of diseases
Glomerular minimal change is a renal disease characterized by massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia. Although it has the word "mild" in the name, it can cause serious complications if left untreated.
| Features | Description |
|---|---|
| Age of onset | It is more common in children and adolescents, but can also occur in adults |
| Pathological characteristics | The glomerular structure was normal under light microscopy, and the foot process was fused under electron microscopy. |
| clinical manifestations | Massive proteinuria (>3.5g/24h), hypoalbuminemia, edema, hyperlipidemia |
2. Causes and pathogenesis
The specific cause of mild glomerular lesions is not yet clear, but may be related to immune system abnormalities, genetic factors, or viral infection. The following are possible pathogenesis mechanisms:
| possible mechanism | Description |
|---|---|
| immune abnormalities | T cell dysfunction leads to podocyte damage |
| genetic factors | Some patients tend to cluster in families |
| viral infection | Such as Epstein-Barr virus and influenza virus may induce |
3. Clinical manifestations
Patients usually present with typical symptoms of nephrotic syndrome, and some patients may be accompanied by hypertension or abnormal renal function.
| Symptoms | incidence |
|---|---|
| Edema | More than 90% |
| proteinuria | 100% |
| hypoalbuminemia | 80%-90% |
| hyperlipidemia | 70%-80% |
4. Diagnosis and differential diagnosis
Diagnosis requires a combination of clinical manifestations, laboratory tests, and renal biopsy. It needs to be differentiated from other causes of nephrotic syndrome (such as membranous nephropathy, FSGS).
| Check items | meaning |
|---|---|
| Urine protein quantification | Confirm the degree of proteinuria |
| serum albumin | Assess for hypoalbuminemia |
| kidney biopsy | gold standard for diagnosis |
5. Treatment and prognosis
Glucocorticoids are the treatment of choice, and 90% of children and 50%-60% of adult patients achieve complete remission. Those who relapse need to adjust the immunosuppressive regimen.
| Treatment | efficient |
|---|---|
| Glucocorticoids | 90% for children, 50%-60% for adults |
| immunosuppressant | For patients with relapse or hormone resistance |
6. Latest research progress (hot spots in the past 10 days)
In July 2024, the International Society of Nephrology released a study stating that new biological agents may provide treatment options for refractory MCD. Several other studies have focused on podocyte repair mechanisms.
Summary:Although the pathological manifestations of minor glomerular lesions are "mild", the clinical impact is significant. Early diagnosis and standardized treatment can improve the prognosis. Patients need to regularly monitor urine protein and renal function.
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