Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
When monitoring patients with Minimal Change Disease (MCD), which is an immune-mediated glomerular disease, it is important to be aware of potential complications that are associated with chronic kidney disease (CKD) and significant proteinuria [4, Angioi et al. 2024].
- Progression of Chronic Kidney Disease (CKD): Patients are at risk of their kidney disease worsening NICE NG203. You should monitor their estimated Glomerular Filtration Rate (eGFR) and Albumin Creatinine Ratio (ACR) regularly to assess the risk of CKD progression NICE NG203. If the ACR is 70 mg/mmol or more, referral for nephrology assessment is indicated NICE CKS,NICE CKS. For an ACR between 30-70 mg/mmol, continued monitoring and considering specialist advice from a nephrologist is appropriate NICE CKS,NICE CKS.
- Acute Kidney Injury (AKI): Individuals with CKD are at an increased risk of developing acute kidney injury NICE NG203.
- Cardiovascular Events: There is a heightened risk of cardiovascular events in patients with CKD NICE NG203. Monitoring blood pressure is crucial, with specific clinic systolic blood pressure targets below 140 mmHg (target range 120 to 139 mmHg) for adults with CKD and an ACR under 70 mg/mmol, and below 130 mmHg (target range 120 to 129 mmHg) for those with an ACR of 70 mg/mmol or more NICE NG203. Additionally, offer atorvastatin 20 mg to all people with CKD for the primary or secondary prevention of cardiovascular disease (CVD) NICE CKS,NICE CKS.
- Hypertension: High blood pressure is a common comorbidity and a risk factor for CKD progression and cardiovascular disease NICE NG203. Regular blood pressure monitoring is essential NICE NG203.
- All-cause Mortality: CKD is associated with an increased risk of all-cause mortality NICE NG203.