Minimal Change Disease (MCD) is one of the most common kidney diseases which usually occurs in the children and accounts for 80%~90% of primary Nephrotic Syndrome (NS) in children and 10%~20% of Aldult Primary NS. It appears more often in men than in women and incidence ratein children is higher than that in adults. The age of the patients are usually 2~6 for children and 30~40 for adults. Among patients with NS who are older than 60 years old, incidence rate of MCD is also high.
Most patients will have the typical manifestation of Nephrotic Syndrome (massive proteinuria; Hypoproteinemia, edema and Hyperlipemia) and only 15% of the patients are accompanied with microscopic hematuria. In general condition, there is no persistent Hypertension or reduced renal function, but transient Hypertension and renal functional damage may be caused by severe retention of water and sodium.
About 1/3 of the patients have upper respiratory tract infection or other infections. Most are with rapid onset and typical cases are mostly presented as obvious NS, which account for 90% of children NS and 20% of adult NS. Patients have normal blood pressure and about 15% of them are accompanied with microscopic hematuria of different degree, the incidence of which increases along with age. This is especially obvious in patients older than 60, among whom the incidence rate of microscopic hematuria is higher because of the interstitial fibrosis and vascular lesions. However, gross hematuria is rarely seen.
Because of low blood volume and decrease of renal perfusion, about 1/3 of the patients have decreased GFR on the first visit. Urinary deposition test shows no cell or cast. In some severe cases, urine protein can be more than 40g/d. In children patients, proteinuria is typical highly selective, which mainly contains albumin and thimbleful of high-molecular-weight protein such as IgG, α2- macroglobulin and C3. But adults present different manifestations. MCD in elderly patients who are more than 60 years old may present non-selective proteinuria, usually accompanied with Hypertension and decline of GFR.
Recent-year study has found that transferrin, whose molecular weight is 88,000 also leaks into tubular fluid because of its spheroidal structural feature. In urine the pH value of which is between 4.5 and 5.5, ferri in the transferring will dissociate into tubular fluid. Fe3+ can damage renal interstitial tubules by producing much oxygen radical or directly cause damage to renal tubules or interstitium. There is no fibrin split product or C3 in the urine. Complement components in blood are normal but may accompany slight fall of C1q. Concentration of IgG is usually very low in period of onset while IgM may have slight rise up in both onset and remission periods. Histocompatibility leukocyte antigen HLA-B12 is obviously common in MCD, promoting a possibility of relationship between this disease and heredity.
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