skip to main content

Minimal change disease — ESENeph MCQ

Instant feedback + full explanation. One question, done properly.

HardGlomerulonephritisMinimal change diseaseESENeph

A 46-year-old man develops ankle swelling 10 days after starting ibuprofen for back pain. Creatinine is 76 micromol/L, albumin 18 g/L and urine PCR 920 mg/mmol. Urine dipstick shows protein 4+ and blood negative; renal biopsy shows normal glomeruli on light microscopy and diffuse podocyte foot process effacement. What is the most likely underlying cause?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — NSAID-associated minimal change disease

The biopsy pattern of normal light microscopy with diffuse foot process effacement is typical of minimal change disease, and NSAIDs are a recognised trigger in adults. Diabetic nodular sclerosis and amyloid cause structural glomerular changes rather than minimal-change histology. Anti-GBM disease presents with nephritic sediment and linear IgG rather than isolated nephrotic syndrome. The pearl is that adult minimal change disease often warrants a careful search for drug, lymphoma and other secondary causes.

Reference: KDIGO 2021 Glomerular Diseases Guideline; BNF