Minimal Change Disease and Focal Segmental Glomerulosclerosis in Adults

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.