Minimal Change Nephrotic Syndrome (MCNS)
MCNS is the most common cause of idiopathic nephrotic syndrome in children, typically presenting between 2 and 6 years of age.
1. Clinical Presentation
- Classic Triad: Massive proteinuria (nephrotic range), hypoalbuminemia, and edema (often periorbital initially, progressing to generalized).
- Associated Findings: Hyperlipidemia, normal blood pressure (usually), and absence of hematuria.
2. Pathogenesis & Diagnosis
| Method | Finding |
|---|---|
| Light Microscopy | Appears normal (minimal change). |
| Immunofluorescence | Negative for immune deposits. |
| Electron Microscopy | Effacement of podocyte foot processes. |
3. Management Principles
- First-line: Oral Corticosteroids (Prednisolone) are the gold standard. Most children respond within 4 weeks (steroid-sensitive).
- Supportive: Salt restriction, diuretics (if severe edema), and prophylactic antibiotics (if signs of infection).
NEET PG Hint: The most important diagnostic step is a therapeutic trial of corticosteroids; a kidney biopsy is NOT indicated for the first presentation in a typical child (2–6 years old) unless they are steroid-resistant. Remember that MCNS is associated with an increased risk of venous thrombosis due to the loss of antithrombin III in the urine.