Complications

Complication
Timeframe
Likelihood
short term
low

Primary peritonitis due to infection with an encapsulated organism can be fatal. Late-onset infections depend on the degree of immunosuppression needed to control minimal change disease.

Immediate treatment with intravenous antibiotics is required.

Spontaneous bacterial peritonitis

short term
low

Although rare in children with minimal change disease, this can occur due to loss of proteins such as antithrombin 3, leading to a procoagulant state.​[43]

Anticoagulation with heparin and warfarin may be required.

Hypercoagulable state

long term
medium

Although most children with minimal change disease (MCD) stop having relapses during their teenage years, the incidence of childhood MCD relapses in adulthood is relatively high. Transition to an adult nephrologist is recommended for all children approaching adulthood.

Few controlled trials have studied the treatment of relapse in adults with MCD. Repeated courses of corticosteroids, cyclophosphamide, cyclosporine, and mycophenolate all seem to play a role.[42] One randomized controlled trial of 11 subjects compared the use of cyclophosphamide versus cyclosporine and showed that both drugs are effective in the treatment of frequent relapses, but 3 other trials investigating a total of 20 subjects tested the use of cyclosporine therapy and showed that cyclosporine, though effective in the treatment of relapse, is associated with an extremely high incidence of subsequent relapses following drug withdrawal. A long-term follow-up cross-sectional study of 95 patients, with 69 relapsers, supported the use of corticosteroids in the treatment of occasional relapses. Powered, multi-centered, blinded randomized controlled trials, with long-term follow-up, are required to investigate the optimal treatment for relapsing adult MCD.[42]

variable
medium

Children with nephrotic syndrome including minimal change disease are at increased risk for infection, particularly with encapsulated organisms such as Pneumococcus (causing pneumonia).

This may be related to increased urinary loss and catabolism of IgG, or to treatment with corticosteroids and immunosuppressants.

variable
low

Children with minimal change disease do not generally present with hypertension. Adults are more likely to have hypertension at the point of diagnosis (25% to 50% of cases).[24][25]

This is best treated with ACE inhibitors, as they also help reduce proteinuria.​​

Evaluation of hypertension

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