WordNet

cause to change; make different; cause a transformation; "The advent of the automobile may have altered the growth pattern of the city"; "The discussion has changed my thinking about the issue" (同)alter, modify
become different in some particular way, without permanently losing ones or its former characteristics or essence; "her mood changes in accordance with the weather"; "The supermarkets selection of vegetables varies according to the season" (同)alter, vary
exchange or replace with another, usually of the same kind or category; "Could you convert my dollars into pounds?"; "He changed his name"; "convert centimeters into inches"; "convert holdings into shares" (同)exchange, commute, convert
a relational difference between states; especially between states before and after some event; "he attributed the change to their marriage"
change clothes; put on different clothes; "Change before you go to the opera"
coins of small denomination regarded collectively; "he had a pocketful of change"
money received in return for its equivalent in a larger denomination or a different currency; "he got change for a twenty and used it to pay the taxi driver"
remove or replace the coverings of; "Father had to learn how to change the baby"; "After each guest we changed the bed linens"
the balance of money received when the amount you tender is greater than the amount due; "I paid with a twenty and pocketed the change"
the result of alteration or modification; "there were marked changes in the lining of the lungs"; "there had been no change in the mountains"
undergo a change; become different in essence; losing ones or its original nature; "She changed completely as she grew older"; "The weather changed last night"
a different or fresh set of clothes; "she brought a change in her overnight bag"
a thing that is different; "he inspected several changes before selecting one"
the action of changing something; "the change of government had no impact on the economy"; "his change on abortion cost him the election"
an event that occurs when something passes from one state or phase to another; "the change was intended to increase sales"; "this storm is certainly a change for the worse"; "the neighborhood had undergone few modifications since his last visit years ago" (同)alteration, modification
an impairment of health or a condition of abnormal functioning
made or become different in some respect; "hes an altered (or changed) man since his election to Congress"
changed in constitution or structure or composition by metamorphism; "metamorphic rocks"
made or become different in nature or form; "changed attitudes"; "changed styles of dress"; "a greatly changed country after the war"
a British imperial capacity measure (liquid or dry) equal to 1/60th fluid dram or 0.059194 cubic centimeters
a United States liquid unit equal to 1/60 fluidram
the least possible; "needed to enforce minimal standards"; "her grades were minimal"; "minimum wage"; "a minimal charge for the service" (同)minimum

PrepTutorEJDIC

(…に)…'を'『変える』,改める《+『名』+『into』+『名』》 / …'を'『取り替える』,交換する / 〈小切手・為替〉'を'現金にする,〈金〉'を'両替えする;(…に)…'を'両替する《+『名』+『into』+『名』》 / (…に)『変わる』,変化する《+『to』(『into』)+『名』》 / (他の衣服に)着替える《+『into』+『名』》 / (…に)乗り換える《+『to』+『名』》 / 〈C〉(…の)『変化』,移り変わり,変遷《+『of』+『名』》 / 〈C〉(…の)『取り替え』,交換;乗り換え《+『of』+『名』》 / 〈U〉釣り銭,小銭
(体の)『病気』,疾患 / (精神・道徳などの)病気,病弊
女性の話術芸人 =diseur
ミニム(液量の最小単位) / 《英》二分音符(《米》half note)
最小の,極小の,最近の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2018/11/24 14:45:18」(JST)

wiki en

Minimal change disease (also known as MCD, minimal change glomerulopathy, and nil disease, among others) is a disease affecting the kidneys which causes a nephrotic syndrome. Nephrotic syndrome leads to the loss of significant amounts of protein in the urine, which causes the widespread oedema (soft tissue swelling) and impaired kidney function commonly experienced by those affected by the disease. It is most common in children and has a peak incidence at 2 to 3 years of age.^[1] MCD is responsible for 10-25% of nephrotic syndrome cases in adults.^[2] It is also the most common cause of nephrotic syndrome of unclear cause (idiopathic) in children.^[2]

Signs and symptoms

The clinical signs of minimal change disease are proteinuria (abnormal excretion of proteins, mainly albumin, into the urine), oedema (swelling of soft tissues as a consequence of water retention), weight gain, and hypoalbuminaemia (low serum albumin). These signs are referred to collectively as nephrotic syndrome. Blood clots may form as a consequence of nephrotic syndrome. Acute kidney injury is seen in 20-25% of affected adults.^[2]

When albumin is excreted in the urine, its serum (blood) concentration decreases. Consequently, the intravascular oncotic pressure reduces relative to the interstitial tissue. The subsequent movement of fluid from the vascular compartment to the interstitial compartment manifests as the soft tissue swelling referred to as oedema. This fluid collects most commonly in the feet and legs, in response to gravity, particularly in those with poorly functioning valves. In severe cases, fluid can shift into the peritoneal cavity (abdomen) and cause ascites. As a result of the excess fluid, individuals with minimal change disease often gain weight, as they are excreting less water in the urine, and experience fatigue. Additionally, the protein in the urine causes it to become frothy.

Pathophysiology

For years, pathologists found no changes when viewing specimens under light microscopy, hence the name "minimal change disease." With the advent of electron microscopy, the changes now known as the hallmarks of the disease were discovered. These are diffuse loss of visceral epithelial cells' foot processes (i.e., podocyte effacement),^[3] vacuolation, and growth of microvilli on the visceral epithelial cells.

The cause and pathogenesis of minimal change disease is unclear and it is currently considered idiopathic. However, it does not appear to involve complement, immunoglobulins, or immune complex deposition. Rather, an altered cell-mediated immunologic response with abnormal secretion of lymphokines by T cells is thought to reduce the production of anions in the glomerular basement membrane, thereby increasing the glomerular permeability to serum albumin^[4] through a reduction of electrostatic repulsion.^[5] The loss of anionic charges is also thought to favor foot process fusion.^[1] The etiological agent is unclear but viruses such as EBV and food allergies have been implicated. Also, the exact cytokine responsible has yet to be elucidated, with IL-12, IL-18 and IL-13 having been most studied in this regard, yet never conclusively implicated.

Genetics

Protein tyrosine phosphatase receptor type O, also known as glomerular epithelial protein 1 (GLEPP1), has been shown to be mutated in a number of cases.^[6]

Diagnosis

Minimal change disease is unique among the causes of nephrotic syndrome as it lacks evidence of pathology in light microscopy, hence the name. Microscopic amounts of blood are present in the urine of 10-30% adults with MCD.^[2]

Treatment

Corticosteroids such as prednisone are first-line treatment for minimal change disease.^[2] Other medications such as ACE inhibitors to reduce the amount of protein in the urine or statins to decrease high levels of cholesterol seen with nephrotic syndrome are generally unnecessary.^[2] ACE inhibitors may be considered in people with MCD who also have high blood pressure.^[2] When the urine is clear of protein, the medications can be discontinued. Fifty percent of patients will relapse and need further treatment with immunosuppressants, such as ciclosporin, tacrolimus, mycophenolate, and rituximab.^[2] There is little evidence to support the use of azathioprine for MCD.^[2]

Minimal change disease usually responds well to initial treatment and over 80% of patients will respond to oral steroids within 16 weeks, with most of these having a complete remission.^[2] Adults with MCD tend to respond more slowly to corticosteroid treatment than affected children.^[2] Symptoms of nephrotic syndrome (NS) typically go away; but, this can take from 2 weeks to many months.^[7] Younger children, who are more likely to develop minimal change disease, usually respond faster than adults. In 2 out of 3 children with minimal change disease, however, the symptoms of NS can recur in a relapse, particularly after an infection or an allergic reaction. This is typical, and usually requires additional treatment. Many children with MCD experience 3 to 4 relapses before the disease starts to resolve. Some children require longer term therapy to keep MCD under control. It appears that the more time without a relapse, the better the chances are that a relapse will not occur. In most children with minimal change disease, particularly among those who respond typically, there is minimal to no permanent damage observed in their kidneys.

With corticosteroid treatment, most cases of nephrotic syndrome from minimal change disease in children will go into remission. This typically occurs faster, over 2 to 8 weeks, in younger children, but can take up to 3 or 4 months in adults. Typically, the dose of corticosteroids will initially be fairly high, lasting 1or 2 months. When urine protein levels have normalised, corticosteroids are gradually withdrawn over several weeks (to avoid triggering an Addisonian crisis). Giving corticosteroids initially for a longer period of time is thought to reduce the likelihood of relapse. The majority of children with minimal change disease will respond to this treatment.

Even among those who respond well to corticosteroids initially, it is common to observe periods of relapse (return of nephrotic syndrome symptoms). 80% of those who get minimal change disease have a recurrence. Because of the potential for relapse, the physician may prescribe and teach the patient how to use a tool to have them check urine protein levels at home. Two out of 3 children who initially responded to steroids will experience this relapse at least once. Typically, the steroids will be restarted when this occurs, although the total duration of steroid treatment is usually shorter during relapses than it is during the initial onset of the disease.

There are several immunosuppressive medications that can be added to steroids when their effect is insufficient, or can replace them if intolerance or specific contraindications are encountered.

Epidemiology

Minimal change disease is most common in very young children but can occur in older children and adults. It is by far the most common cause of nephrotic syndrome in children between the ages of 1 and 7, accounting for the majority (about 90%) of these diagnoses.^[8] Among teenagers who develop nephrotic syndrome, it is caused by minimal change disease about half the time. It can also occur in adults but accounts for less than 20% of adults diagnosed with nephrotic syndrome. Among children less than 10 years of age, boys seem to be more likely to develop minimal change disease than girls. Minimal change disease is being seen with increasing frequency in adults over the age of 80.

People with one or more autoimmune disorders are at increased risk of developing minimal change disease. Having minimal change disease also increases the chances of developing other autoimmune disorders.

Etymology

Minimal change disease has been called by many other names in the medical literature, including minimal change nephropathy, minimal change nephrosis, minimal change nephrotic syndrome, minimal change glomerulopathy, foot process disease (referring to the foot processes of the podocytes), nil disease (referring to the lack of pathologic findings on light microscopy), nil lesions, lipid nephrosis, and lipoid nephrosis.

References

^ ^a ^b Kumar V, Fausto N, Abbas A, eds. (2003). Robbins & Cotran Pathologic Basis of Disease (7th ed.). Saunders. pp. 981–2. ISBN 978-0-7216-0187-8.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k Hogan, J; Radhakrishnan, J (April 2013). "The treatment of minimal change disease in adults". Journal of the American Society of Nephrology. 24 (5): 702–11. doi:10.1681/ASN.2012070734. PMID 23431071.
^ "Renal Pathology". Retrieved 2008-11-25.
^ "Minimal_change_disease of the Kidney". Archived from the original on 2009-01-10. Retrieved 2008-11-25.
^ Mathieson P (2003). "Immune dysregulation in minimal change nephropathy". Nephrol Dial Transplant. 18 (Suppl 6): vi26–9. PMID 12953038.
^ Ozaltin F, Ibsirlioglu T, Taskiran EZ, et al. (July 2011). "Disruption of PTPRO causes childhood-onset nephrotic syndrome". American Journal of Human Genetics. 89 (1): 139–47. doi:10.1016/j.ajhg.2011.05.026. PMC 3135805. PMID 21722858.
^ "Archived copy". Archived from the original on 2008-04-30. Retrieved 2008-04-16.
^ Cameron JS (September 1987). "The nephrotic syndrome and its complications". Am. J. Kidney Dis. 10 (3): 157–71. doi:10.1016/s0272-6386(87)80170-1. PMID 3307394.

External links

UpToDate Contents

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1. 成人における微小変化群の治療 treatment of minimal change disease in adults
2. 成人における微小変化群の病因、臨床的特徴、および診断 etiology clinical features and diagnosis of minimal change disease in adults
3. 小児におけるネフローゼ症候群の病因、臨床症状、および診断 etiology clinical manifestations and diagnosis of nephrotic syndrome in children
4. 微小変化群やその他のネフローゼ症候群における急性腎障害（AKI） acute kidney injury aki in minimal change disease and other forms of nephrotic syndrome
5. 重症蛋白尿およびネフローゼ症候群の概要 overview of heavy proteinuria and the nephrotic syndrome

English Journal

T helper (Th)-cytokines in the urine of patients with primary glomerulonephritis treated with immunosuppressive drugs: Can they predict outcome?

Kalavrizioti D1, Gerolymos M2, Rodi M3, Kalliakmani P4, Provatopoulou S5, Eleftheriadis T6, Mouzaki A7, Goumenos DS8.
Cytokine.Cytokine.2015 Dec;76(2):260-9. doi: 10.1016/j.cyto.2015.08.002. Epub 2015 Aug 22.
BACKGROUND: Glomerulonephritides (GNs) represent common causes of chronic kidney disease associated with a wide spectrum of clinical and histological features. Various factors that activate the inflammatory cascade are involved in the development of kidney injury. The aim of this study was to estima
PMID 26307557

Functional dyspepsia.

Holtmann G1, Talley NJ.
Current opinion in gastroenterology.Curr Opin Gastroenterol.2015 Nov;31(6):492-8. doi: 10.1097/MOG.0000000000000219.
PURPOSE OF REVIEW: Structural causes are absent in more than 50% of patients with symptoms referred to the gastroduodenal region when routine diagnostic tests are applied. New knowledge holds the prospect that targeted therapy may more optimally manage subsets of these patients with functional dyspe
PMID 26444826

A predictive model of progressive chronic kidney disease in idiopathic nephrotic syndrome.

Mendonça AC1, Oliveira EA1, Fróes BP1, Faria LD2, Pinto JS2, Nogueira MM2, Lima GO2, Resende PI2, Assis NS2, Simões E Silva AC1, Pinheiro SV3.
Pediatric nephrology (Berlin, Germany).Pediatr Nephrol.2015 Nov;30(11):2011-20. doi: 10.1007/s00467-015-3136-0. Epub 2015 Jun 18.
BACKGROUND: There are limited data on the risk factors for chronic kidney disease (CKD) in children with idiopathic nephrotic syndrome (INS). This retrospective cohort study aimed to develop a predictive model for CKD progression in children with INS.METHODS: Between 1970 and 2012, a total of 294 pa
PMID 26084617

Japanese Journal

Epidemiologic Methods of Assessing Asthma and Wheezing Episodes in Longitudinal Studies: Measures of Change and Stability

Soto-Ramírez Nelís,Ziyab Ali H.,Karmaus Wilfried,Zhang Hongmei,Kurukulaaratchy Ramesh J.,Ewart Susan,Arshad Syed Hasan
Journal of Epidemiology, 2013
… Background: In settings in which diseases wax and wane, there is a need to measure disease dynamics in longitudinal studies. … Traditional measures of disease occurrence (eg, cumulative incidence) do not address change or stability or are limited to stable cohorts (eg, incidence) and may thus lead to erroneous conclusions. …
NAID 130003364526

Relapse of minimal change disease following infection with the 2009 pandemic influenza (H1N1) virus

KIM Seo Rin,LEE Soo Bong,KIM Il Young,LEE Dong Won,RHEE Harin,SEONG Eun Young,SONG Sang Heon,KWAK Ihm Soo
Clinical and experimental nephrology 16(2), 329-332, 2012-04-01
NAID 10030739136

The incidence and distribution of biopsy-proven renal diseases in children

Nakashima Yumiko,Nazneen Arifa,Abe Kuniko,Nakayama Toshiyuki,Taguchi Takashi,Shirakawa Toshihiko,Moriuchi Hiroyuki
Acta Medica Nagasakiensia 57(1), 19-24, 2012-04-00
… Among the total biopsycases, the most common renal disease identified in childhood was IgA glomerulonephritis (IgAGN; … 10.6%), and thin basement membrane disease (7.1%). … One of the major causes of pediatric nephrotic syndrome wereminimal change nephrotic syndrome (58%), whereas the other causes were IgAGN (11.6%), HSPN (8.9%), membranousglomerulonephritis (5.4%), membranoproliferative glomerulonephritis (3.6%). …
NAID 110009226245

Related Pictures

★リンクテーブル★

リンク元	「微小変化群」「MCD」「lipoid nephrosis」「nil lesion」
関連記事	「disease」「change」「minimal」

「微小変化群」

Classification	D ICD-10: N00-N08 with .0 suffix; ICD-9-CM: 581.3; DiseasesDB: 8230;
External resources	MedlinePlus: 000496; eMedicine: med/1483;

Minimal change disease
	The three hallmarks of minimal change disease: diffuse loss of podocyte foot processes, vacuolation, and the appearance of microvilli.
Specialty	Urology

　　[★]

英: minimal change disease
同: 微少変化群、微小糸球体変化 minor glomerularabnormality、リポイドネフローゼ lipoid nephrosis; 微小変化型ネフローゼ症候群 minimal change nephrotic syndrome, MCNS
関: 一次性ネフローゼ症候群、原発性ネフローゼ症候群

概念

光学顕微鏡で糸球体に変化が認められないが電子顕微鏡で異常が認められる。
小児に多い。
小児のネフローゼ症候群の約80％を微小変化群がしめる。
成人のネフローゼ症候群の約20％を微小変化群がしめる。

疫学

小児に多い(2-6歳)。蛋白尿で発見(学校検尿で)

治療

ステロイドによく反応するが、再発も多い

予後

予後は良好→消失（治療する必要もなし）　←　？？？？
小児例

90%の症例でステロイドに反応して寛解。寛解例の2/3で再発し、いくらかはステロイド依存状態となる。25年後に5%の例で慢性腎不全となる。この群の殆どの人が巣状分節状糸球体硬化症をともなうネフローゼ症候群を呈している。(BPT.550)

成人例

ステロイド療法に反応するが、治療への反応は小児例より遅く、また再発しやすい。(BPT.550)

病理

光学顕微鏡、蛍光で異常な変化（－）、電子顕微鏡で観察できる（＋）

[show details]

電子顕微鏡で足細胞の足突起の消失(足突起の癒合)が見られる

国試

105I057：微小変化群によるネフローゼ症候群　→　循環血漿量減少　→　腎前性腎不全

「MCD」

　　[★]

「lipoid nephrosis」

　　[★] 微小変化群 minimal change disease

「nil lesion」

　　[★]

関: minimal change disease

「disease」

　　[★]

n.

疾患：illnessより厳密な概念。「ある臓器に明確な障害が確認され、それによって症状が出ているとはっきり説明できる場合」 (PSY.9)

特定の原因、病態生理、症状、経過、予後、病理組織所見が全てそろった場合 (PSY.9)

something that is very wrong with people's attitudes, way of life or with society.

関: ail、ailment、disease entity、disorder、ill、illness、malady、sick、sickness

注意

disease ≠ illness ≠ disorder

「change」

　　[★]

n.

変化、変更、交替

v.

関: alter、alteration、alternate、convert、modification、modify、replacement、shift、switch、turn、turn to、variation、variational、vary

「minimal」

　　[★]

adj.

最小の、極小の

関: local minimum、minimally、minimum

[Robbins_2005-1] Kumar V, Fausto N, Abbas A, eds. (2003). Robbins & Cotran Pathologic Basis of Disease (7th ed.). Saunders. pp. 981–2. ISBN 978-0-7216-0187-8.

[Hogan2013-2] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k Hogan, J; Radhakrishnan, J (April 2013). "The treatment of minimal change disease in adults". Journal of the American Society of Nephrology. 24 (5): 702–11. doi:10.1681/ASN.2012070734. PMID 23431071.

[3] "Renal Pathology". Retrieved 2008-11-25.

[4] "Minimal_change_disease of the Kidney". Archived from the original on 2009-01-10. Retrieved 2008-11-25.

[Mathieson_2003-5] Mathieson P (2003). "Immune dysregulation in minimal change nephropathy". Nephrol Dial Transplant. 18 (Suppl 6): vi26–9. PMID 12953038.

[Ozaltin2011-6] Ozaltin F, Ibsirlioglu T, Taskiran EZ, et al. (July 2011). "Disruption of PTPRO causes childhood-onset nephrotic syndrome". American Journal of Human Genetics. 89 (1): 139–47. doi:10.1016/j.ajhg.2011.05.026. PMC 3135805. PMID 21722858.

[unckidneycenter-7] "Archived copy". Archived from the original on 2008-04-30. Retrieved 2008-04-16.

[cameron-8] Cameron JS (September 1987). "The nephrotic syndrome and its complications". Am. J. Kidney Dis. 10 (3): 157–71. doi:10.1016/s0272-6386(87)80170-1. PMID 3307394.

匿名

検索

案内

案内

minimal change disease