## Minimal Change Disease in Nephrotic Syndrome **Key Point:** Minimal change disease (MCD) is the most common cause of nephrotic syndrome in children, accounting for 85–90% of cases in children aged 2–6 years. ### Epidemiology - **Peak incidence:** 2–6 years of age - **Gender:** Slight male predominance - **Worldwide prevalence:** Most common cause globally in the pediatric population ### Pathological Features - **Light microscopy:** Glomeruli appear normal (hence "minimal change") - **Electron microscopy:** Effacement of podocyte foot processes (diagnostic finding) - **Immunofluorescence:** Negative (no immune deposits) — this is key to distinguishing from other forms ### Clinical Presentation - Sudden onset of nephrotic syndrome (proteinuria >3.5 g/day, hypoalbuminemia, edema, hyperlipidemia) - Selective proteinuria (mainly albumin) - Normal renal function at presentation - Normal complement levels ### Prognosis - Excellent response to corticosteroids (90% remission rate) - Most children achieve complete remission with treatment - Relapse rate: 30–40% after initial remission **High-Yield:** In any child presenting with nephrotic syndrome, assume MCD until proven otherwise. The absence of hematuria, normal complement, and excellent steroid responsiveness support this diagnosis. **Clinical Pearl:** The presence of systemic features (fever, arthralgia, rash) or hematuria should prompt investigation for secondary causes or other glomerular diseases.
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