A Profile of Minimal Change Nephropathy in Adults at the Witwatersrand Academic Complex (2001–2010)

Abstract

Abstract Background: Minimal change nephropathy (MCN) is amongst the commonest causes of nephrotic syndrome worldwide, accounting for up to 15% of cases of primary nephrotic syndrome in adults. Limited data is available in African subjects. Methods: We retrospectively reviewed the demographic, clinical profile and treatment outcomes of adult patients presenting with primary MCN at the Witwatersrand Academic Complex between 2001 and 2010. Results: Forty-seven cases of MCN (2.9%) were diagnosed in 1618 patients undergoing native kidney biopsy. The patients with MCN were predominantly of Black race (83%), the male-to-female ratio was 1.04:1 and the mean age was 31.8 ± 12.1 years. Records of treatment and outcomes were available for 28 patients, all of whom received initial corticosteroid therapy (average dose of prednisone 0.8 mg/kg/day). The mean duration of steroid therapy was 24.8 ± 19.0 months. About 57.1% of patients achieved remission with no further relapse and 39.2% had probable steroid resistance. The mean time to relapse was 27.8 ± 19.4 months with 83% of patients relapsing within 48 months. The mean time to relapse was significantly longer in males (39.3 ± 17.5 months) compared to females (18 ± 16.9 months) (P = 0.09). Conclusion: MCN is rare amongst adult Black Africans but should be considered in the differential diagnosis of nephrotic syndrome. The disorder in these patients may be less responsive to corticosteroids and a longer course of therapy may be required to induce remission. Males may be more likely to remain in remission for a longer period.