History and exam

Key diagnostic factors

common

facial or generalized edema

Supports the diagnosis of nephrotic syndrome but is not specific for minimal change disease. ​​Onset is gradual, ranging from a few days to several weeks.

age >1 year but <8 years

Patients with underlying minimal change disease (MCD) are usually between the ages of 2 and 8 years. MCD nephrotic syndrome is uncommon in children <1 year of age.

Other diagnostic factors

common

normal BP

Presence of hypertension makes minimal change disease less likely in children. Adults are more likely to have hypertension at the point of diagnosis (25% to 50% of cases).[24][25]

absence of hematuria

Most patients do not present with hematuria, although in the International Study of Kidney Disease in Children hematuria was seen in 23% of patients with minimal change disease.[20]

history of recent viral illness

Onset often follows a recent viral illness, supporting the hypothesis that dysregulation of the immune system plays a role in development.

uncommon

dyspnea

A few patients may present with signs of complications, including respiratory distress (consequence of pleural effusion or pneumonia).[4]

history of lymphoma or leukemia

May help differentiate children with minimal change disease from those with other glomerular pathology.[20]

Risk factors

strong

age >1 year but <8 years

Differentiates MCD from other causes of nephrotic syndrome.[20]

Hodgkin lymphoma

MCD can be a manifestation of classic Hodgkin lymphoma. Nephrotic syndrome can be the initial presenting symptom in some patients and a late manifestation of the lymphoma in others.[21]

leukemia

MCD, focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, and membranous nephropathy have been associated with leukemia.[22]

recent viral illness

Dysregulation of the immune system seems to play a role in the development of nephrotic syndrome, including MCD nephrotic syndrome. This hypothesis is supported by the observation that a viral illness can precede the initial presentation or, in many cases, a relapse in known nephrotic patients.

weak

hepatitis B or C infection

Can cause nephrotic syndrome; biopsy may reveal MCD, but other histologic varieties can also occur.

low birth weight (LBW)

Has been shown to lead to a low nephron endowment with subsequent glomerular hyperfiltration. Consequently, LBW has been shown to have an adverse effect on the course and prognosis of MCD in children.[23]

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