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Minimal change disease — ABIM Board MCQ

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ModerateNephrologyMinimal change diseaseABIM Board

A 42-year-old has nephrotic syndrome with 9 g/day proteinuria, albumin 1.9 g/dL and preserved eGFR. Biopsy shows diffuse podocyte foot-process effacement without immune deposits. Secondary causes and infection have been excluded. Which initial disease-directed therapy is preferred?

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Correct answer: A — Begin high-dose oral glucocorticoid therapy

The best answer is “Begin high-dose oral glucocorticoid therapy”. This is adult minimal-change disease; high-dose glucocorticoids are standard initial therapy after secondary causes and treatment contraindications are considered. Steroid-sparing agents are important for selected relapsing, dependent or resistant disease, not mandatory first treatment for every adult.

Reference: KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases: https://kdigo.org/guidelines/gd/