Electron microscopy of a renal biopsy from a 10-year-old with nephrotic syndrome shows diffuse effacement of podocyte foot processes, no immune deposits, and normal light microscopy. What is the MOST likely diagnosis?

• A Membranous nephropathy
• B Focal segmental glomerulosclerosis
• C IgA nephropathy
• D Minimal change disease ✓

Explanation

Minimal change disease (MCD) is the most common cause of nephrotic syndrome in children. The hallmark on electron microscopy is diffuse podocyte foot process effacement with no electron-dense deposits; light microscopy appears normal (hence 'minimal change'). It is T-cell mediated and responds dramatically to steroids. Membranous nephropathy shows subepithelial deposits and FSGS shows segmental sclerosis on light microscopy.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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