MCD - Minimal change disease and treatment with steroids...

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Minimal change disease and treatment with steroids 7/24/2007 Zae Kim, MD
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Clinical Question Why does MCD respond to steroid? Why do they develop resistance?
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Introduction Most common cause of the nephrotic syndrome in children ~10-15% of nephrotic syndrome in adults, third most common after MN and FSGS More common in Hispanics, Asians, Arabs and Caucasians clinical and pathological entity defined by selective proteinuria and hypoalbuminemia that occurs in the absence of cellular glomerular infiltrates or immunoglobulin deposits
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Light microscopy of glomerulus in MCD
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Immunofluorescence Microscopy www.gamewood.net/rnet/renalpath/noimcx.jpg
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Electron Microscopy
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The glomerular capillary wall Van den Berg, Weening, Clinical Science (2004) 107, 125–136 Normal MCD
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What is the Pathogenesis?
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Pathogenesis - “Intrinsic factor” Genetic basis for hereditary NS NS of the Finnish type Autosomal-recessive steroid-resistant NS Familial forms of FSGS Diffuse mesangila sclerosis associated with Denys-Drash syndrome and with Frasier syndrome NS associated with nail-patella syndrome Help elucidate molecular aspect of FSGS Not clear for MCD
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Molecular anatomy of the podocyte foot process cytoskeleton Nature Genetics 24 , 333 - 335 (2000)
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Pathogenesis – extrinsic factor, better explanation for MCD Clinical Observations - Shalhoub’s hypothesis MCD frequently remits with measles infection Corticosteroids and alkylating drugs cause a remission
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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MCD - Minimal change disease and treatment with steroids...

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