title: Proteinuria predicts relapse in adolescent and adult minimal change disease.
abstract: OBJECTIVE
  This study sought to outline the clinical and laboratory characteristics of minimal change disease in adolescents and adults and establish the clinical and laboratory characteristics of relapsing and non-relapsing patients.
  
  
  METHODS
  We retrospectively evaluated patients with confirmed diagnoses of minimal change disease by renal biopsy from 1979 to 2009; the patients were aged >13 years and had minimum 1-year follow-ups.
  
  
  RESULTS
  Sixty-three patients with a median age (at diagnosis) of 34 (23-49) years were studied, including 23 males and 40 females. At diagnosis, eight (12.7%) patients presented with microscopic hematuria, 17 (27%) with hypertension and 17 (27%) with acute kidney injury. After the initial treatment, 55 (87.3%) patients showed complete remission, six (9.5%) showed partial remission and two (3.1%) were nonresponders. Disease relapse was observed in 34 (54%) patients who were initial responders (n = 61). In a comparison between the relapsing patients (n = 34) and the non-relapsing patients (n = 27), only proteinuria at diagnosis showed any significant difference (8.8 (7.1-12.0) vs. 6.0 (3.6-7.3) g/day, respectively, p = 0.001). Proteinuria greater than 7 g/day at the initial screening was associated with relapsing disease.
  
  
  CONCLUSIONS
  In conclusion, minimal change disease in adults may sometimes present concurrently with hematuria, hypertension, and acute kidney injury. The relapsing pattern in our patients was associated with basal proteinuria over 7 g/day.
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Division of Nephrology, São Paulo/SP, Brazil. cristianebitencourt@uol.com.br
authors.forename: Cristiane Bitencourt
authors.initials: CB
authors.lastname: Dias
authors.forename: Cilene Carlos
authors.initials: CC
authors.lastname: Pinheiro
authors.forename: Vanessa dos Santos
authors.initials: Vdos S
authors.lastname: Silva
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Hagemann
authors.forename: Rui Toledo
authors.initials: RT
authors.lastname: Barros
authors.forename: Viktoria
authors.initials: V
authors.lastname: Woronik
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006417:Hematuria / Q000175:diagnosis* / Q000652:urine*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009402:Nephrosis, Lipoid / Q000175:diagnosis* / Q000188:drug therapy / Q000652:urine*; D011507:Proteinuria / Q000175:diagnosis* / Q000652:urine*; D012008:Recurrence; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult