A 35-year-old woman presents with nephrotic syndrome: 6 g/day proteinuria, albumin 2.0 g/dL, and cholesterol 380 mg/dL. Renal biopsy shows effacement of podocyte foot processes on electron microscopy with no immune deposits on immunofluorescence. Light microscopy is normal. What is the most likely diagnosis and first-line treatment?

• A IgA nephropathy; RAAS blockade
• B FSGS; cyclosporine as first-line
• C Membranous nephropathy; rituximab
• D Minimal change disease (MCD); prednisolone (1 mg/kg/day for 8–12 weeks) ✓

Explanation

The biopsy triad of normal light microscopy, no immune deposits on immunofluorescence, and podocyte foot process effacement on electron microscopy is pathognomonic of minimal change disease (MCD), the most common cause of nephrotic syndrome in children and common in adults. First-line treatment is oral prednisolone at 1 mg/kg/day (maximum 80 mg) for 8–12 weeks. Over 80–90% of adults respond, though relapse is common (steroid-dependent or frequently relapsing MCD). Cyclosporine, tacrolimus, or rituximab are used for steroid-dependent or resistant cases.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.