Patient handout

Minimal Change Disease

PRODUCTION

1. Your condition

This handout is for minimal change disease. Your care team identified this based on: sudden onset anasarca / periorbital + dependent edema (kdigo 2021 gn).

Other reasons your team may use this plan: nephrotic-range proteinuria upcr >3.5 g/g (adult) or >2 g/g (pediatric) (kdigo 2021 gn); severe hypoalbuminemia <2.5-3.0 g/dl with nephrotic syndrome (kdigo 2021 gn); renal biopsy with diffuse foot-process effacement on em, no lm/if abnormality (kdigo 2021 gn).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
prednisone	Adult: 1 mg/kg PO daily (max 80 mg) × 4-16 wk to remission then 6 wk taper. Pediatric: 60 mg/m²/d (max 60 mg) × 4-6 wk then 40 mg/m² (max 40 mg) every other day × 4-6 wk.	PO	daily	KDIGO 2021 GN — ~80-90% achieve complete remission; pediatric ISKDC pattern, adult slower (up to 16 wk for first remission)

Plan: MCD steroid-responsive ladder — induction → relapse → steroid-sparing (CNI/CY/RTX/MMF) → rituximab refractory → supportive bundle (KDIGO 2021 GN; Hodson NIPNS Cochrane; Cravedi adult MCD 2009)

3. When to call your provider

Contact your care team if any of the following happen:

Rising UPCR + falling albumin → relapse → reinitiate induction (KDIGO 2021 GN)
No response to induction at 4 wk pediatric / 16 wk adult → re-biopsy for FSGS (KDIGO 2021 GN)
New fever + neutropenia on immunosuppression → ED (KDIGO 2021 GN)
CKD progression toward ESRD → transplant evaluation; route neph.ckd.core.v1 (KDIGO 2024 CKD)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Adult-onset idiopathic MCD — biopsy mandatory; slower response to steroid (4-16 wk for first remission) (KDIGO 2021 GN; Korbet)
Paraneoplastic MCD — Hodgkin lymphoma association; B symptoms + adenopathy + LDH; renal often improves with lymphoma treatment (KDIGO 2021 GN)
Steroid-dependent (relapse on or within 2 wk of taper) OR frequently relapsing (≥2 in 6 mo / ≥4 in 12 mo) — escalate to CNI / CY / rituximab / MMF (KDIGO 2021 GN; Hodson Cochrane)
Steroid-resistant MCD — failure to remit after 4 wk pediatric or 16 wk adult induction → REBIOPSY to exclude FSGS / IgM nephropathy / atypical lesion (KDIGO 2021 GN)
Severe hypoalbuminemia <2.0-2.5 g/dL → high VTE / renal vein thrombosis risk; anticoag prophylaxis indicated (KDIGO 2021 GN; Lin nephrotic anticoag)
Nephrotic infection susceptibility — opsonin loss (IgG + factor B) + lymphopenia on steroid; SBP, cellulitis, pneumonia, encapsulated organisms (KDIGO 2021 GN)
Acute AKI during nephrotic relapse — hemodynamic from volume contraction, severe proteinuria-related tubular injury, or renal vein thrombosis (KDIGO 2021 GN; KDIGO 2012 AKI)

5. Follow-up

Relapse counseling + bone protection (steroid exposure) + vaccinations (annual flu, COVID, PCV20) + steroid-sparing planning if SD/FR + post-transplant recurrence counseling (KDIGO 2021 GN)

6. Sources

Guideline: KDIGO 2021 Glomerular Diseases + Cochrane corticosteroid therapy for childhood nephrotic syndrome (2015) + KDIGO 2024 CKD