Minimal change Glomerulonephritis (Nil) causes, diagnosis, treatment,prognosis

This is not a true glomerulonephritis due to absence of inflammation & inflammatory cells.
- Common in children (> 85% to 90% of nephrotic syndrome in children).
- 20 % of adult nephrotic syndrome .
- It is steroid sensitive.
- There is selective proteinuria.
- Spontaneous remission in 40-50% of cases may occur.
- Renal failure usually does not occur .
Causes:
1. Primary: Idiopathic.
2. Secondary : NSAID - lymphoma.
Clinical Picture
- Nephrotic syndrome : Here

Microscopic examination:

- Light microscope : Almost normal (nil)
- E.M :       Fusion of foot process of epithelial cells or effacement.
- Immunoflorescence: -ve (nil) - (no antibodies or complement).
Treatment:
- Prednisolone 60 mg/ni orally for 4 wks or until proteinuria disappears (the average body surface area is 1.73 m2).
- When the urine has been free from proteins continue the drug for 2 weeks then prednisolone should be gradually reduced over 4 wks.
- For those who have frequent relapses and require repeated courses of corticosteroids, the use of alternate day prednisolone therapy may reduce the incidence of steroid toxicity.

Cyclophosphamide may be used.2 mg/kg/d & continued for 2 weeks after remission or withdrawn after 6 weeks if no response .
Indications:
- Steroid resistant cases.
- Steroid dependent cases.
- Frequent relapses
Recently cyclosporine can also be used.

Prognosis:
- There is remission and exacerbation.
- Relapses occurring many years later are recoqnized but even in the long term there does not seem to be any deterioration of renal function .

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