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Introduction

Minimal change disease (MCD) is a type of nephrotic syndrome caused by glomerular podocyte dysfunction.  MCD is the most common cause of nephrotic syndrome in children (~90% of cases), but it can also develop in adults (~10% of cases of nephrotic syndrome in adults).

Pathophysiology

The pathogenesis of MCD likely begins with dysregulation of T-cell subpopulations.  Dysfunctional T cells cause an overproduction of glomerular permeability factor (eg, IL-13) that damages the capillary wall of the glomerulus, leading to cytokine-mediated disruption of the actin cytoskeleton within podocytes, resulting in podocyte injury and effacement ( Figure 1).  Podocyte effacement causes a loss of charge selectivity across the glomerular basement membrane, resulting in the selective loss of urinary anions (particularly albumin) and leading to massive proteinuria.  The resulting hypoalbuminemia leads to decreased plasma oncotic pressure with renal sodium retention, resulting in acute-onset, gravity-dependent edema (eg, periorbital, scrotal, tibial).

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