Minimal Change Disease - Treatment

Treatment

Prednisone is prescribed along with a blood pressure medication, typically an ACE inhibitor such as lisinopril. Some nephrologists will start out with the ACE inhibitor first in an attempt to reduce the blood pressure's force which pushes the protein through the cell wall in order to lower the proteinuria. In some cases a corticosteroid may not be necessary if the case of minimal change disease is mild enough to be treated just with the ACE Inhibitor. Often the liver is overactive with minimal change disease in an attempt to replace lost protein and over produces cholesterol. Therefore a statin drug is often prescribed for the duration of the treatment. When the urine is clear of protein, the drugs can be discontinued. 50% of patients will relapse and need further treatment with immunosuppressants such as cyclosporine and tacrolimus.

Minimal change disease usually responds well to initial treatment and over 90% of patients will respond to oral steroids within 6–8 weeks, with most of these having a complete remission. Symptoms of nephrotic syndrome (NS) typically going away, but this can take from 2 weeks to many months. Younger children, who are more likely to develop minimal change disease, usually respond faster than adults. In 2 out of 3 children with minimal change disease, however, the symptoms of NS can recur, called a relapse, particularly after an infection or an allergic reaction. This is typical, and usually requires additional treatment. Many children experience 3 to 4 relapses before the disease starts to go away. Some children require longer term therapy to keep MCD under control. It appears that the more time one goes without a relapse, the better the chances are that a relapse will not occur. In most children with minimal change disease, particularly among those who respond typically, there is minimal to no permanent damage observed in their kidneys.

With steroid treatment, the symptoms of nephrotic syndrome (NS) will go away, called remission, in the majority of children with minimal change disease. This typically occurs faster, over 2 to 8 weeks, in younger children, but can take up to 3 or 4 months in adults. Typically the dose of steroids will initially be fairly high, lasting 1or 2 months. At some point after the urine protein levels have become normal again, the dose of steroids might be switched to an every-other-day schedule, then very slowly reduced over the course of several months. It is very important to taper, or gradually reduce, the dose of steroids. The body does not respond well to a sudden discontinuation of steroids, and this might also trigger a relapse, or return, of NS symptoms. Giving steroids initially for a longer period of time is thought to reduce the likelihood of relapse. The majority of children with minimal change disease will respond to this treatment.

Even among those who respond well to steroids initially, it is common to observe periods of relapse (return of NS symptoms). Because of the potential for relapse, the physician may prescribe and teach the patient how to use a tool to have you check urine protein levels at home. Two out of 3 children who initially responded to steroids will experience this at least once. Typically the steroids will be restarted when this occurs, although the total duration of steroid treatment is usually shorter during relapses than it is during the initial treatment of the disease.

There are several immunosuppressive medications that can be added to steroids when the effect is not sufficient or replace them in case of intolerance or specific contraindications.