Minimal change disease

Minimal change disease is the commonest cause of nephrotic syndrome in children and third most common cause in adults. There are new insights in the pathogenesis of disease, and it is now considered a podocyte disorder. New biomarkers have been identified to explain the pathogenesis. The treatment in children is almost standardised, however in adults, the evidence is not so robust and treatment is mostly extrapolated from randomized trials in children and uncontrolled or retrospective studies in adults. The long term prognosis of disease is excellent in children and steroid sensitive patients. Steroid resistance is a marker of poor prognosis. Genetic studies are helpful in detecting patients with mutations, as, they do not respond to immunosuppressive drugs. The therapeutic armamentarium of treatment of MCD has widened with discovery of new immunosuppressive drugs like tacrolimus, mycophenolate mofetil and rituximab, which are helpful in treatment of steroids resistant and steroid dependent nephrotic syndrome.