What is minimal change disease?
Minimal change disease is the most common cause of nephrotic syndrome in children who are over 1-year old.
In nephrotic syndrome, the tiny filters in the kidney become leaky, letting protein escape into the urine from the blood. This results in protein becoming detectable in the urine, called proteinuria, and swelling, often around the eyes, abdomen, feet and legs.
What are the causes of minimal change disease?
In almost all cases, the cause of damage to the tiny filters in minimal change disease is unknown although there is strong evidence that activation of the immune system plays a major part.
In rarer cases, minimal change disease can develop following another condition or from taking certain medications. This includes some types of infection and cancer, allergies, and other conditions that affect the tiny filters of the kidney. Medications include NSAIDs, such as Ibuprofen.
What are the symptoms of minimal change disease?
Symptoms of nephrotic syndrome include:
- Protein in the urine, called proteinuria (which can be detected by a urine dipstick test)
- Swelling, often around the eyes, abdomen, feet and legs
In some cases, there may be a small amount of blood in the urine visible under the microscope.
How is minimal change disease diagnosed?
Signs of minimal change disease in children include large amounts of protein in the urine, usually with swelling. Because minimal change disease is the most common cause of nephrotic syndrome in children, doctors will usually start treatment straight away if a child has these signs.
In adults, and some children, a renal biopsy is used to diagnose minimal change disease. Usually, the changes to the tiny filters, called the glomeruli, are not visible under a light microscope. This is why it is called ‘minimal change’ disease. The changes to these filters can be seen using a special high-power microscope called an electron microscope, which will show changes to podocytes, a type of cell within the glomeruli.
What are the treatments for minimal change disease?
Treatments for minimal change disease include:
Corticosteroids. In most cases this type of medicine will decrease the protein leak into the urine and symptoms of the condition will go away within a few weeks. But symptoms can return, which is called a relapse, and you should continue to take this medicine for as long as your doctor recommends.
Other immunosuppressant therapies. Most patients respond to corticosteroids. However, in some cases corticosteroids don’t work, which is called steroid resistant nephrotic syndrome. Sometimes, corticosteroids can work to begin with, but the condition may keep returning. In these cases, you may be given other immunosuppressant therapies, which are medicines that can be used to protect healthy tissue from unwanted targeting by the immune system.
Treatments to manage the symptoms of minimal change disease include:
- Medicines called diuretics which decrease the build-up of fluid (swelling) in your body
- Diet changes to reduce salt intake as this can help decrease the build-up of fluid in your body
In some cases, minimal change disease and its symptoms can go away, and you won’t need any further treatment.
What is the prognosis for minimal change disease?
Most patients with minimal change disease will respond well to corticosteroids and the condition and its symptoms will go away or reduce in frequency
In rarer cases, patients with minimal change disease develop kidney disease which can progress to kidney failure. Treatment options for kidney failure include transplant and dialysis.
Prognosis for patients with minimal change disease will depend on the cause, severity, how the disease progresses and treatment response.
References
O’Brien, F. Minimal Change Disease [online]. MSD Manual, Merck & Co, Inc., Rahway, NJ, USA; Apr 2025. [Accessed 1 April 2026]. Available from: Minimal Change Disease - Nephrology - MSD Manual Professional Edition
Tidy, C. Nephrotic syndrome. Patient.info, Navigate Health Ltd: London, UK; Jun 2022 [Accessed 1 April 2026]. Available from: Nephrotic Syndrome: Symptoms and Treatment | Doctor
NHS. Nephrotic syndrome in children [online]. Nhs.uk, England; Oct 2022 [Accessed 1 April 2026]. Available from: Nephrotic syndrome in children - NHS
Zamora, G. Pearson-Shaver, A. L. Minimal Change Disease [online]. 2023. Treasure Island (FL): StatPearls Publishing. [Accessed 1 April 2026]. Available from: <PMID: 32809474>
Reviewed June 2026 by Professor Moin Saleem at the University of Bristol
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