What are the potential complications of Minimal Change Disease that I should monitor for in my patients?

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 ⁴. You should monitor their estimated Glomerular Filtration Rate (eGFR) and Albumin Creatinine Ratio (ACR) regularly to assess the risk of CKD progression ⁴. If the ACR is 70 mg/mmol or more, referral for nephrology assessment is indicated ¹,². For an ACR between 30-70 mg/mmol, continued monitoring and considering specialist advice from a nephrologist is appropriate ¹,².
• Acute Kidney Injury (AKI): Individuals with CKD are at an increased risk of developing acute kidney injury ⁴.
• Cardiovascular Events: There is a heightened risk of cardiovascular events in patients with CKD ⁴. 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 ⁴. Additionally, offer atorvastatin 20 mg to all people with CKD for the primary or secondary prevention of cardiovascular disease (CVD) ¹,².
• Hypertension: High blood pressure is a common comorbidity and a risk factor for CKD progression and cardiovascular disease ⁴. Regular blood pressure monitoring is essential ⁴.
• All-cause Mortality: CKD is associated with an increased risk of all-cause mortality ⁴.