A 22-year-old woman presents with nephrotic syndrome: proteinuria 8 g/day, albumin 2.1 g/dL, oedema. Renal biopsy shows effacement of podocyte foot processes on electron microscopy with no immune deposits on immunofluorescence and normal light microscopy. What is the diagnosis and the first-line treatment?
- A Minimal change disease; prednisolone 1 mg/kg/day ✓
- B Focal segmental glomerulosclerosis; calcineurin inhibitor
- C Membranous nephropathy; rituximab
- D IgA nephropathy; ACE inhibitor
Correct answer: A. Minimal change disease; prednisolone 1 mg/kg/day
Explanation
Minimal change disease (MCD) characteristically shows: no abnormality on light microscopy, no immune deposits on immunofluorescence, and diffuse podocyte foot process effacement on electron microscopy. MCD is the most common cause of nephrotic syndrome in children and the second most common in adults. First-line treatment is corticosteroids (prednisolone 1 mg/kg/day up to 80 mg/day) with a response expected in 8–16 weeks. FSGS has segmental sclerosis on LM; membranous nephropathy shows subepithelial deposits with spike-and-dome pattern.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.