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Minimal change disease

Key sources
The following summarized guidelines for the evaluation and management of minimal change disease are prepared by our editorial team based on guidelines from the Kidney Disease: Improving Global Outcomes Foundation (KDIGO 2021; 2012) and the Japanese Society of Nephrology (JSN 2016).
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Guidelines

1.Classification and risk stratification

Prognosis: recognize that long-term kidney survival is excellent in patients with MCD responding to corticosteroids, but less certain for patients not responding.
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2.Diagnostic procedures

Kidney biopsy: perform kidney biopsy to diagnose MCD in adult patients.
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3.Medical management

Corticosteroids: as per KDIGO 2021 guidelines, initiate high-dose corticosteroids for no longer than 16 weeks as initial treatment in adult patients with MCD unless contraindicated.
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  • Immunosuppressants

  • Supportive therapy

4.Therapeutic procedures

Renal replacement therapy: consider initiating RRT as indicated in adult patients with MCD and AKI, together with corticosteroids as for a first episode.
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5.Follow-up and surveillance

Assessment of treatment response: define complete remission as reduction of proteinuria to < 0.3 g/day or protein-to-creatinine ratio < 300 mg/g (or < 30 mg/mmol), stable serum creatinine and serum albumin > 3.5 g/dL (or 35 g/L).
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  • Management of relapse (corticosteroids)

  • Management of relapse (immunosuppressants)