POS-449 ADULT ONSET MINIMAL CHANGE DISEASE: CLINICAL CHARACTERISTICS, TREATMENT AND PROGNOSIS

Abstract

Minimal change disease (MCD) is an uncommon glomerulopathy in adults, accounting for almost 15 to 20% of nephrotic syndrome (NS) unlike children in whom MCD is the most common cause of NS accounting for almost 80 % of cases. Most MCD patients respond well to steroids and have a preserved renal function. However, MCD remains a therapeutic challenge for the nephrologist especially for frequently relapsing, steroid dependent, and steroid resistant NS.This study aimed to describe characteristics and outcomes of adult patients with MCD. This is a retrospective study including adult patients having NS with biopsy proven MCD from January 2006 to December 2019 in a nephrology department. Were collected all patients’ characteristics including clinical, biological, histological and etiological features, as well as therapeutic and prognostic outcomes. 66 adult patients with biopsy proven MCD were analyzed. 56% were male. Mean age at presentation was 35.8±15.18 years. At diagnosis, all patients had edema. 9.09% patients had hypertension. 14.3% patients had microscopic hematuria. 12.12% patients had acute renal failure. Mean creatinine was 88,54±46,34 µmol/L. Mean daily proteinuria was 8.39±4.9 g/l. 74.6% patients had a pur NS. In biopsy, 6.06% patients had particularly mesangial proliferation and 12.1% had IgM deposits. Secondary causes of MCD were seen in 21.2% of cases (atopy in 78.6% and drugs in 21.4%). 6.25% patients had spontaneous remission. Remission rate was 93.3% but 69.3% patients had relapsed. 4.16% patients were frequent relapsers, 20.8% were steroid dependent and 6.25% were steroid resistant. Immunosuppressive therapy was needed in 6 patients. 14.58% patients had chronic renal failure and 2 progressed to end-stage renal disease. Patient survival was of 95.8% at 13 years. Relapses of MCD are common in adults and their treatment is challenging. However MCD remains a benign lesion with a good long-term prognosis and few patients progressing to end-stage renal disease.