Minimal-change glomerulonephritis is a special type of glomerulonephritis. The condition is also referred to by the abbreviation MCGN by some doctors. Minimal-change glomerulonephritis represents a disease that occurs primarily in young children.
What is minimal change glomerulonephritis?
In numerous cases, minimal-change glomerulonephritis is the trigger for the so-called nephrotic syndrome, which affects some children. With particularly high frequency, minimal-change glomerulonephritis occurs in children between the ages of two and six. About 90 percent of all cases with this syndrome occur at this age. This compares to only 10 to 15 percent in adult patients. Some medical professionals advocate calling minimal change glomerulonephritis because the disease lacks certain features of inflammation. Basically, minimal-change glomerulonephritis is a disease that primarily affects the renal corpuscles. While kidney function is not affected by the disease in most cases in pediatric patients, some adult individuals show a slight decrease in kidney function. In rare cases, acute failure of the organ occurs.
Causes
Several factors are discussed as causes of minimal-change glomerulonephritis. In the majority of cases, it is an idiopathic disease. This means that the specific causes for the development of minimal change glomerulonephritis are not identifiable and thus unknown. Thus, it is the exception rather than the rule that causes for the disease can be identified in a patient. Possible triggers include certain drugs, such as non-steroidal anti-inflammatory drugs. However, agents such as interferon, ampicillin and lithium are also responsible for some cases of the disease. In addition, some diseases favor the development of minimal-change glomerulonephritis. These are, for example, leukemias and Hodgkin’s disease. In addition, the disease sometimes occurs in association with carcinomas of the renal cells or pancreas and together with thymomas. Minimal-change glomerulonephritis may also be seen in association with carcinomas of the prostate. Some speculate that the cells of the tumors secrete special cytokines. In principle, however, co-occurrence with carcinomas is comparatively rare.
Symptoms, complaints, and signs
The symptoms associated with minimal-change glomerulonephritis are varied and may differ slightly among patients with the disease. The main symptom of the disease is nephrotic syndrome, which occurs acutely. It is manifested by proteinuria as well as hypoproteinemia and hyperlipoproteinemia. In addition, edema is possible as a result of hypalbuminemia. The level of the substance creatinine in the serum of the blood is usually not noticeable in patients of childhood. However, in adult individuals, the concentration may be minimally elevated. In addition, adult patients exhibit an increase in blood pressure in numerous cases. In rare cases, the kidney of affected individuals fails acutely.
Diagnosis and course of the disease
Minimal-change glomerulonephritis is diagnosed using a variety of investigative procedures. In any case, if a person shows the typical symptoms of minimal-change glomerulonephritis, a physician should be consulted as soon as possible. The latter examines the present complaints, first taking a medical history with the affected patient. With regard to the clinical examination, for example, analyses of the tissue of the kidney are used. The corresponding tissue comes from a puncture of the kidney. It is also possible to use an electron microscope to examine the tissue samples. This reveals typical indications of minimal-change glomerulonephritis. An analysis of the urine is also essential, whereby numerous symptoms of the disease can be detected. A kidney biopsy usually confirms the diagnosis of minimal-change glomerulonephritis.
Complications
In most cases, minimal-change glomerulonephritis occurs only in young children. The affected individuals themselves suffer from severely elevated blood pressure.This complaint can have a negative impact on the patient’s health and lead to various other ailments. In the worst case, high blood pressure can also cause a heart attack and death. Likewise, it is not uncommon for spontaneous bleeding or a bloody taste in the mouth to occur, especially during high stress. Furthermore, minimal change glomerulonephritis can lead to kidney complaints, so that in the worst case the affected person suffers from kidney insufficiency. This must be treated urgently, as otherwise the patient will die. During treatment, the affected person is primarily dependent on dialysis, with the transplantation of a kidney being the goal. As a result, minimal-change glomerulonephritis also significantly reduces life expectancy. As a rule, the disease can be cured very well with the help of medication, so that the symptoms disappear completely and are limited. Further complications do not occur. Treatment can also be repeated in the event of a recurrence.
When should you go to the doctor?
Discomfort during urination, as well as tiredness and fatigue, are often signs of a health disorder. If the discomfort persists or increases in intensity, a doctor is needed. Low blood pressure, a pale complexion, or listlessness are indications of an existing irregularity that needs further monitoring. If high blood pressure develops in the further course, a medical clarification becomes necessary. If breathing noises, reduced physical performance or reduced participation in social activities occur, a physician is needed. The majority of cases occur in children, so that special features in the behavior of the offspring should be discussed with a physician. In case of irritability, depressive states, listlessness and apathy, a doctor should be consulted. If kidney dysfunction occurs, a doctor must be consulted as soon as possible. In case of organ failure, there is a potentially life-threatening condition that should be avoided. The development of edema, swelling on the body or changes in the appearance of the skin should be investigated and treated. If circulatory disturbances are apparent, or if there are noticeable changes in weight or a general feeling of illness, a physician should be consulted. If an acute condition of concern develops, emergency medical services must be alerted. First aid measures must be applied immediately to ensure the survival of the affected person.
Treatment and therapy
In the majority of cases, glucocorticoids show very good results in the therapy of minimal-change glomerulonephritis. In more than 90 percent of patients, proteinuria disappears completely after administration. In particular, people in childhood respond well to the corresponding active ingredient. For this reason, a biopsy of the kidney is not usually performed in them. In children, improvement usually occurs after a few weeks. The situation is different in adult patients, in whom it sometimes takes several months for treatment with the active substance to show results. A kidney biopsy is mandatory here. As soon as the condition of the affected individuals and in particular the proteinuria improves, the glucocorticoids are gradually reduced in dose. However, proteinuria develops again in a large proportion of affected patients even after successful treatment. A small proportion of those suffering from minimal-change glomerulonephritis will develop renal impairment of a terminal nature within the next two decades. In pediatric patients, the medical agent prednisone is often used. The dose is comparatively high at the beginning of administration. After a certain time, the physician reduces the dosage of the drug. This type of therapy usually shows success in child patients after one month at the latest. However, relapses occur in numerous individuals.
Outlook and prognosis
In principle, a favorable prognosis can be assumed. Minimal-change glomerulonephritis may even heal on its own. In children under ten years of age, this is statistically the case in four out of ten cases. Treatment leads to a complete cure in one third of the patients.In the rest, minimal-change glomerulonephritis persists to the end of life. Complications cannot be ruled out. Medications have to be taken permanently. The quality of life sometimes suffers from the existing symptoms. If, on the other hand, the disease does not appear until adulthood, the prognosis is usually worse. The treatment period until the effectiveness of the medication and therapeutic approaches is also extended. Two aspects that may worsen the outlook prove to be problematic. On the one hand, minimal-change glomerulonephritis recurs in some cases. The recurrence rate is about 30 percent after successful therapy. On the other hand, a good five percent of all patients develop terminal renal failure over a period of 25 years. This can be fatal. Both can only be countered by consistent follow-up care, which means that patients never finally get rid of minimal-change glomerulonephritis. This risk can be a psychological burden in everyday life.
Prevention
Prevention of minimal-change glomerulonephritis is limited because the specific causes of the disease are often unclear in individual cases.
Follow-up
The symptoms can usually be alleviated or even completely cured with medication, so that those affected can live with the disease. The disease does not bring further complications. In case of recurrence, the same treatment is applied. Affected individuals should generally strive for a healthy lifestyle with adequate sleep and exercise and pay attention to a balanced diet. Moderate exercise boosts the immune system and contributes to general well-being. If affected persons suffer from renal insufficiency, they are dependent on regular monitoring by the physician caring for them in order to avoid further complications. Sometimes, life expectancy is significantly reduced in sufferers of minimal-change glomerulonephritis.
Here’s what you can do yourself
There are no known ways to help yourself with minimal-change glomerulonephritis, so the condition must always be examined and treated by a doctor. Only by taking medication can the symptoms be completely relieved and the disease fought. In children, a biopsy of the kidney is usually not necessary and the symptoms disappear after a few weeks. Adults, however, are dependent on a biopsy, and the healing of minimal-change glomerulonephritis in adults can take several months. Because the disease can cause lasting damage to the kidneys, patients depend on regular checkups to avoid further complications. Since the causes of minimal-change glomerulonephritis are also still unclear, the disease cannot be prevented directly. If the disease leads to high blood pressure, blood-thinning medication can be taken after consultation with a physician. In this case, it is advisable to check the blood pressure regularly. In the case of psychological complaints, conversations with other sufferers of minimal-change glomerulonephritis often help, as this can lead to an exchange of information. Furthermore, conversations with one’s friends or family are also very helpful in preventing depression and other psychological upsets.
