Minimal-change nephropathy

Renal function impairment Renal impairment, including minimal change nephropathy, and acute and chronic interstitial nephritis, has occurred. 

Patients with renal diseases leading to the nephrotic syndrome often present complex problems in volume management. These patients may exhibit fluid retention in the form of ascites or edema but have reduced plasma volume due to reduced plasma oncotic pressures. This is very often the case in patients with "minimal change" nephropathy. In these patients, diuretic use may cause further reductions in plasma volume that can impair GFR and may lead to orthostatic hypotension. Most other causes of nephrotic syndrome are associated with primary retention of salt and water by the kidney, leading to expanded plasma volume and hypertension despite the low plasma oncotic pressure. In these cases, diuretic therapy may be beneficial in controlling the volume-dependent component of hypertension. 

Gil. Guasch, A., and Myers, B. D., Determinants of glomerular hypofiltration in nephrotic patients with minimal change nephropathy. J. Am. Soc. Nephrol. 4, 1571-1581 (1994). 

Proximal renal tubnlar proteinuria is a possible complication in patients treated with high doses of mesalazine, and it is clearly important to monitor renal function in these patients (SEDA-22, 394) (75). Two studies in 21 (76) and 95 (77) patients with ulcerative colitis and Crohn s disease have shown that proteinuria of tubular marker proteins is common and is related to disease activity rather than to treatment with mesalazine. Thus, tubular proteins are not useful predictors of an adverse renal response to the drug. Nephrotic syndrome with minimal change nephropathy has been described with sulfasalazine and mesalazine (SEDA-16, 427). 

Renal papillary necrosis and interstitial nephritis with the nephrotic syndrome have been documented (27,28). Other cases of the nephrotic syndrome, with or without renal insufficiency, which were apparently due to minimal-change nephropathy (which is relatively more common in NSAID users), have been reported (29,30). The unusual feature of diclofenac-associated renal interstitial mucinosis has been described (SEDA-17, 109). 

Wolters J, van Breda Vriesman PJ. Minimal change nephropathy and interstitial nephritis associated with diclofenac. Neth J Med 1985 28(8) 311-14. 

Beun GD, Leunissen KM, Van Breda Vriesman PJ, Van Hooff JP, Grave W. Isolated minimal change nephropathy associated with diclofenac. BMJ (Clin Res Ed) 1987 295(6591) 182-3. 

Pemphigus and nephrosis (minimal change nephropathy) (375) Pemphigus and myasthenia gravis (376)... 

Isenring P, de Cotret PR, Delage C, Kingma I, Lebel M. d-Penicillamine induced reversible minimal change nephropathy in rheumatoid arthritis. J Nephrol 1991 4 245-8. 

Savill JS, Chia Y, Pusey CD. Minimal change nephropathy and pemphigus vulgaris associated with penicillamine treatment of rheumatoid arthritis. Clin Nephrol 1988 29(5) 267-70. 

Wolters J, Frederik P, van Rie H, Zeppenfeldt E. Minimal change nephropathy during gold treatment. A case with unusual his-topathological and immunopathological features. Netherland J Med 1987 31 234-240. 

Interferon Proteinuria in up to 5 to 20% patients Rarely nephritic syndrome or/and acute renal failure (acute interstitial nephrotoxicity and minimal change nephropathy ... 

Among all the types of glomerulonephritis, minimal-change nephropathy is most responsive to treatment. Steroids can induce good responses in most patients during initial treatment as well as relapse. 

FIGURE 47-7. Treatment algorithm for minimal-change nephropathy. (Modified from Bargman. )... 

The immunosuppressive effect of cytotoxic agents, with or without the concurrent use of steroids, can result in serious infections, which are the primary cause of death in patients with minimal-change nephropathy. Other toxicities associated with cyclophosphamide include gonadal fibrosis, which results in sterility, hemorrhagic cystitis, alopecia, and a potential to develop malignancy in those on long-term treatment. Patients on chronic steroid therapy often develop growth retardation, osteoporosis, obesity, and cataracts. ... 

The presenting clinical features in nephrotic adults with minimal-change nephropathy can be indistinguishable from that of FSGS, and renal biopsy is therefore critical in the treatment of adults with nephrotic syndrome. FSGS is two to four times more common in black patients than in white patients. They tend to present with proteinuria more frequently in the nephrotic range and are more likely to experience a rapid decline in renal function. 

A 50-year-old man with pancolitis, who was taking sulfasalazine 1 g bd, developed the nephrotic syndrome, with peripheral and eyelid edema, dyspnea, proteinuria, hypoalbumine-mia, hypercholesterolemia, and a raised eryth-roc5rte sedimentation rate, but the serum urea and creatinine concentrations were normal. A renal biopsy showed changes consistent with minimal change nephropathy, probably caused by sulfasalazine, which was withdrawn. Oral methylprednisolone was introduced, and within 1 week the edema disappeared, the proteinuria resolved, and the other laboratory tests began to normalize. He remained asymptomatic after withdrawal of methylprednisolone. 

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