Minimal change disease

Each kidney is made of more than a million units called nephrons, which filter blood and produce urine.

Minimal change disease is due to damage to the glomeruli. These are the tiny blood vessels inside the nephron where blood is filtered to make urine and waste is removed. The condition gets its name because this damage is not visible under a regular microscope. It can only be seen under a very powerful microscope called an electron microscope.

Minimal change disease is the most common cause of nephrotic syndrome in children. It is also seen in adults with nephrotic syndrome, but is less common.

The cause is unknown, but the condition may occur after or be related to:

• Allergic reactions
• Use of non-steroidal anti-inflammatory drugs (NSAIDs)
• Tumors
• Vaccinations (flu and pneumococcal, though rare)
• Viral infections

There may be symptoms of nephrotic syndrome, including:

• Foamy appearance of the urine
• Poor appetite
• Swelling (especially around the eyes, feet and ankles, and in the abdomen)
• Weight gain (from fluid retention)

Minimal change disease does not reduce the amount of urine produced. It rarely progresses to kidney failure.

Your health care provider may not be able to see any signs of the disease, other than swelling. Blood and urine tests reveal signs of nephrotic syndrome, including:

• High level of cholesterol in the blood
• High levels of protein in the urine
• Low levels of albumin in the blood

A kidney biopsy and examination of the tissue with an electron microscope can show signs of minimal change disease.

Medicines called corticosteroids (or steroids) can cure minimal change disease in most children. Some children may need to stay on steroids to keep the disease from returning.

Steroids are very effective in children, but are less often effective in adults. Adults may have more frequent relapses and become dependent on steroids.

If steroids are not effective, your provider will likely suggest other medicines.

Swelling may be treated with:

• ACE inhibitor medicines
• Blood pressure control
• Diuretics (water pills)

You may also be told to reduce the amount of salt in your diet.

Children usually respond better to corticosteroids than adults. Children often respond within the first month of treatment.

A relapse can occur. The condition may improve after long-term treatment with corticosteroids and medicines that suppress the immune system (immunosuppressants).

Contact your provider if:

• You develop symptoms of minimal change disease
• You have this condition and your symptoms get worse
• You develop new symptoms, including side effects from the medicines used to treat the disorder

Minimal change nephrotic syndrome; Nil disease; Lipoid nephrosis; Idiopathic nephrotic syndrome of childhood

Erkan E. Nephrotic syndrome. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 567.

Saha MK, Pendergraft WF, Jennette JC, Falk RJ. Primary glomerular disease. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 31.

Updated by: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.