genitourinary disorders
Minimal Change Disease
Treatment of Minimal Change Disease
Corticosteroids Sometimescyclophosphamide, calcineurin inhibitors (eg,cyclosporineortacrolimus),mycophenolatemofetil, orrituximab Spontaneous remissions occur in 40% of cases, but most patients are given corticosteroids. About 80 to 90% of patients respond to initial high-dose corticosteroid therapy (eg,prednisone60 mg/m2orally once a day for 4 to 6 weeks in children and 1 to 1.5 mg/kg orally once a day for 6 to 8 weeks in adults), but 40 to 73% of responders relapse. Patients who respond (ie, have cessation of proteinuria or a diuresis if edema is present) should continueprednisonefor another 2 weeks and change to a maintenance regimen to minimize toxicity (2 to 3 mg/kg on alternate days for 4 to 6 weeks in children and for 8 to 12 weeks in adults, tapering during the next 4 months). More prolonged initial therapy and slower tapering ofprednisonelower relapse rates. Nonresponsiveness may be due to underlying focal sclerosis that was missed on biopsy due to sampling error. Treatment is usually continued for 1 to 2 years. However, half or more relapse, requiring treatment with the same or a different regimen. 10% of adults), frequent relapsers, and corticosteroid-dependent patients, prolonged remission may be achieved with the addition of another immunosuppressive agent ( Treatment references ). These agents include 1.Larkins NG, Liu ID, Willis NS, et al: Non-corticosteroid immunosuppressive medications for steroid-sensitive nephrotic syndrome in children.Cochrane Database Syst Rev4(4):CD002290, 2020. doi: 10.1002/14651858.CD002290.pub 2.Azukaitis K, Palmer SC, Strippoli GF, et al: Interventions for minimal change disease in adults with nephrotic syndrome.Cochrane Database Syst Rev3(3):CD001537, 2022. doi: 10.1002/14651858.CD001537.pub5 