What is the prognosis of minimal-change disease (MCD)?

Updated: Jan 05, 2021
  • Author: Abeera Mansur, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Use of antibiotics and glucocorticoids and better-organized schedules of management have substantially reduced the mortality rates associated with MCD. Deaths still occur from disease complications.

Relapses eventually cease. Only approximately 5% of children continue to have steroid-responsive relapses when older than 18 years.

Ling et al reported that urinary levels of CD80 have prognostic value in chlidren with MCD. In their study of 64 children with nephrotic syndrome, progression to chronic kidney disease occurred in 2.9% of those with CD80 levels above 328.98 ng/g creatinine, compared with 41.4% of those with levels below that threshold (P < 0.001). The predicted response to immunosuppression therapy was 100% in patients with high urinary CD80 levels, versus 34.5% in those with low levels (P < 0.001). [16]

Adults have a similarly good prognosis. Survival rates of 85-90% are observed 10 years or more after disease onset. An observational study of 78 adult patients found that although 10% were steroid-resistant, 98% achieved remission by a median of 5 weeks; 61% relapsed, at a median of 11 months, and patients had a median of 2 relapses during follow-up. Risk of relapse was increased in patients with a higher estimated glomerular filtration rate, and early relapse occurred significantly more often in women. Five patients subsequently developed focal segmental glomerulosclerosis; those patients had a lower baseline creatinine, a higher serum albumin, and a longer time to remission and were more likely to have steroid-resistant disease. [37]

Chronic kidney disease is extremely rare in patients who are steroid responsive. If chronic kidney disease occurs, the possibility that the pathologic lesion is different or has evolved must be considered.


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