Minimal Change Disease in Children

Minimal change disease, also known as minimal change nephropathy is the most common cause of childhood nephrotic syndrome. It accounts for about 70% to 90% of all children (younger than 10) with nephrotic syndrome.

It is more common among boys than girls and the ratio between male and female is 2:1 and the peak age is 2 to 4 years old. About 80% of the diseased children is younger than 6. Most patients have sudden onset and there are some cases have infections especially upper respiratory tract infections.

Edema is the most common symptom and other typical and obvious symptoms and signs are massive proteinuria (more than 3.5g/d), hypoalbuminemia and hyperlipidemia. In the beginning, the edema appears in the eyes and ankles and in the later stage patients can have pleural effusion and ascites. Ascites can cause abdominal pains and in such cases the possibilities of peritonitis, deep vein thrombosis and pancreatitis should be ruled out. And in case of severe edema, there can be subcutaneous tissue fracture, purple lines or even seepage.

Usually there is no gross hematuria and the incidence of microscopic hematuria is about 13%. In the early stage the blood pressure is usually normal and there is no azotemia.

At present the treatments for minimal change nephropathy is mainly hormones such as prednisone and glucocorticoid which can help alleviate proteinuria and edema in short time and the effects are very obvious. However the disease is very easy to relapse under some inducements such as cold, fever or infections. What is worse, long term intake of hormones will further lower the children’s immunity and make them more susceptible to infections and colds and they are easy to fall into a vicious circle, not to mention the unfavorable side effects which will not only affect their physical development but also mental development.

This is a dilemma that needs to be solved. However, at present there are no effective substitutes for hormones and what we can do is to try to reduce its side effects and try to improve the children immunity. Some herbal medicines can help alleviate the side effects of hormones and cytotoxic drugs and help make the children stronger. For example, Chinese herbal medicine Leguminosae can promote the production of albumin in the liver so as to alleviate edema and hypoalbuminemia.