TheScientificWorldJOURNAL (2005) 5, 828–833
ISSN 1537-744X; DOI 10.1100/tsw.2005.106
©2005 with author.
The Diagnosis of Minimal Change Disease in
M. Barry Stokes
Department of Pathology, Renal Pathology Laboratory, VC14-224, Columbia University
College of Physicians and Surgeons, New York, NY 10032; Tel: 212-342-0055/Fax: 212-
Received August 10, 2005; Revised September 24, 2005; Accepted September 26, 2005; Published September 29, 2005
Proteinuria is common in diabetic patients and usually reflects the presence of diabetic
glomerulosclerosis. This paper reviews the differential diagnosis of proteinuria in diabetic
patients and discusses the role of renal biopsy examination in identification and
management of minimal change disease in this cohort. Identification of nondiabetic
glomerular disease requires careful correlation of clinical history and renal biopsy findings
and may have important implications for prognosis and therapy.
KEYWORDS: diabetes; nephrotic syndrome; minimal change disease
Diabetes is the single leading cause of end-stage renal disease in the U.S. and Western Europe. The
cumulative incidence of kidney disease in both type I and type II diabetes mellitus is approximately 25%
after 20 years. The natural history of diabetic nephropathy is best described for type I diabetes where the
onset of disease is more clearly defined. Following a clinically silent phase of 5–10 years, in which there
may be elevated glomerular filtration rate and glomerular hypertrophy, patients develop microalbuminuria
(30–300 mg/day) accompanied by normal renal function. Glomerular findings at this stage range from near
normal with minimal mesangial expansion, to mild diabetic glomerulosclerosis. Renal biopsies of type 2
diabetics with microalbuminuria may show severe tubulointerstitial, vascular, or glomerulosclerosis
attributable to aging and/or hypertension. Over time, a subset of microalbuminuric patients develops overt
diabetic nephropathy, characterized by increasing proteinuria, hypertension, and progressive renal failure.
The pathologic findings consist of progressively more severe diffuse or nodular glomerulosclerosis. In most
cases of diabetic nephropathy, renal function declines inexorably and progresses to end-stage renal disease,
although some patients have shown remission of proteinuria and stabilization of renal function with ACE
A subset of patients with diabetic nephropathy develop nephrotic syndrome, characterized by urinary
protein excretion greater than 3.5 g/day, hypoalbuminemia, hypercholesterolemia, and peripheral edema
usually after a long period of subnephrotic proteinuria and accompanied by progressive renal failure. The
onset of nephrotic syndrome in diabetic subjects without a prodrome of subnephrotic proteinuria suggests the
possibility of a superimposed nondiabetic glomerular disease.
Stokes: Minimal Change Disease in Diabetic Nephropathy
TheScientificWorldJOURNAL (2005) 5, 828–833
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This article should be referenced as follows:
Stokes, M.B. (2005) The diagnosis of minimal change disease in diabetic nephropathy. TheScientificWorldJOURNAL 5, 828–
833. DOI 10.1100/tsw.2005.106.
R. Agarwal, Editorial Board Member for Nephrology — a domain of TheScientificWorldJOURNAL.