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Effacement of podocyte foot processes
88%
225/256
Subepithelial ‘spike and dome’ deposits
3%
8/256
Subepithelial humps
2%
6/256
Thin glomerular basement membrane
4%
9/256
Subendothelial thickening
1%
3/256
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The clinical scenario describes a child suffering from minimal change disease. In minimal change disease, effacement of podocyte foot processes can be seen upon electron microscopy. Edema, hyperlipidemia, and urine protein excretion of greater than 3.5 grams over 24 hours are cardinal features of nephrotic syndrome. Minimal change disease (lipoid nephrosis) is the most common cause of nephrotic syndrome in children aged 1-7 and is often responsive to steroid treatment. Focal segmental glomerular sclerosis is also common in children and produces nephrotic syndrome. However, the disease is less consistently responsive to steroid treatment than minimal change disease and does not produce characteristic findings upon electron microscopy. Gibson et al. discuss management of childhood nephrotic syndrome. Complications can arise from chronic steroid use and include hypertension, obesity, and linear growth retardation. Steroid-sparing regimens also require monitoring, and can produce varied adverse effects. Cho et al. review the pathophysiology of minimal change disease. Some data suggest T cells release a cytokine permeability factor that injures glomerular epithelial cells. Epithelial cell damage may in turn lead to albuminuria by altering polyanions, such as heparan sulfates, that form much of the charge barrier to the glomerular filtration of albumin. Illustration A shows the three hallmarks of minimal change disease: diffuse loss of podocyte foot processes, vacuolation, and the appearance of microvilli. Incorrect Answers: Answer 2: Subepithelial ‘spike and dome’ deposits are characteristic of membranous glomerulonephritis. Answer 3: Subepithelial humps are characteristic of acute proliferative glomerulonephritis, also known as acute poststreptococcal glomerulonephritis. Answer 4: A thin glomerular basement membrane is characteristic of Alport's syndrome. Answer 5: Subendothelial thickening is characteristic of membranoproliferative glomerulonephritis. Bullet Summary: Effacement of podocyte foot processes is seen in minimal change disease.
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