Minimal change disease is a common cause of nephrotic syndrome in pediatric patients. The presence of certain clinical findings may indicate that an alternative diagnosis should be considered.
Findings which are not typical in minimal change disease in a child:
(1) age of onset < 1 year of age
(2) positive family history
(3) presence of anemia, skin rash, arthritis or other extra-renal complaints
(4) hypertension, pulmonary edema or other signs of expansion in the intra-vascular volume
(5) renal failure with elevation in serum creatinine
(6) red blood cell casts or gross hematuria
(7) failure of proteinuria to respond to 8 weeks of corticosteroid therapy
(8) presence of a disease associated with nephrotic syndrome (viral hepatitis, drugs, autoimmune disease, leukemia, lymphoma, etc.)
• About a quarter of patients with minimal change disease will have persistent microscopic hematuria.
• Hypertension may be seen in 5-7% of children (it is seen more often in adults).
• Elevations in serum BUN are common.
If a patient has one or more of these findings:
(1) an alternative diagnosis should be considered
(2) performance of a renal biopsy should be considered
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Specialty: Nephrology, Clinical Laboratory