A 65-year-old man with CKD stage G3b (eGFR 32 mL/min) and proteinuria 1.8 g/day is on an ACE inhibitor. Serum potassium is 5.8 mEq/L. He develops worsening oedema and serum albumin falls to 2.2 g/dL. Renal biopsy shows effacement of foot processes with no immune deposits on immunofluorescence. The diagnosis is minimal change disease (MCD) in an adult. The CORRECT initial treatment is:

• A Cyclophosphamide pulse therapy immediately
• B Tacrolimus alone as steroids worsen CKD
• C Rituximab as first-line for adult MCD
• D High-dose prednisolone 1 mg/kg/day (maximum 80 mg) until remission, then taper ✓

Explanation

Minimal change disease in adults is treated with high-dose corticosteroids as first-line therapy, as in children. KDIGO 2021 guidelines recommend oral prednisolone 1 mg/kg/day (maximum 80 mg) or alternate-day 2 mg/kg (maximum 120 mg) for at least 4 weeks, continuing until complete remission is achieved (up to 16 weeks before declaring steroid resistance). Adults respond more slowly than children (50–75% achieve remission by 8 weeks vs. 90% in children by 8 weeks). Tacrolimus or rituximab are reserved for frequently relapsing, steroid-dependent, or steroid-resistant MCD.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.