Chapter 15
Minimal Change Disease and Focal Segmental Glomerulosclerosis in Adults
Book Editor(s):Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS,
Donald A. Molony MD,
Giovanni F.M. Strippoli MD, PhD, MPH, MM (Epi),
Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS
Matthew Flinders Distinguished Professor Vice President and Executive Dean
College of Medicine and Public Health, Flinders University, Adelaide, Australia
Search for more papers by this authorDonald A. Molony MD
Professor of Medicine Distinguished Teaching Professor of the University of Texas System
Division of Renal Diseases and Hypertension AND Center for Clinical Research and Evidence-based Medicine, McGovern Medical School University of Texas, Houston, TX, USA
Search for more papers by this authorGiovanni F.M. Strippoli MD, PhD, MPH, MM (Epi)
Professor of Nephrology Adjunct Professor of Epidemiology
Department of Emergency and Organ Transplantation – University of Bari, Bari, Italy
School of Public Health, University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorFirst published: 18 November 2022
Summary
Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are the two key forms of idiopathic nephrotic syndrome. This chapter examines the evidence for management of MCD and FSGS in adults. Minimal change disease presents as nephrotic syndrome of sudden onset. In adults proteinuria is less selective than in children. MCD and FSGS are both examples of pathogenic mechanisms that primarily affect the podocyte. Abnormal T cell dysfunction has long been implicated. However, no consensus has yet been reached regarding a single cell subset. Response to steroid therapy was the most important factor for preservation of renal function. Infectious complications are commonly seen in nephrotic patients due to mass proteinuria and use of immunosuppressive agents. Corticosteroids remain the mainstay of first-line treatment of MCD in adults. Current consensus remains that corticosteroids with full dose and extended period of time are the first-line of therapy in nephrotic FSGS.
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