Management of minimal lesion glomerulonephritis: evidence-based recommendations

The treatment of idiopathic minimal lesion disease in children has been extensively studied in randomized controlled trials, however, there is less information available for adults. This article summarizes evidence-based recommendations for management. The first attack should be treated with prednisone or prednisolone at 60 mg/m2 per day (up to a maximum of 80 mg/day) for four to six weeks, followed by 40 mg/m2 of prednisone every other day for another four to six weeks (grade A). Relapse should be treated with 60 mg/m2/day of prednisone (up to 80 mg/day) only until the urine becomes protein free for three days, and then an alternate day regimen of 40 mg/m2 should be used for another month (grade A). Patients with frequently relapsing disease will have a significant reduction in relapse frequency after eight weeks of an alkylating agent (grade A). Less rigorous studies have suggested benefit with long-term, alternate-day corticosteroid (grade D) or the antihelminthic agent levamisole (grade D). For patients with steroid-dependent disease, an 8- or 12-week course with cyclophosphamide can induce remission (grade D). In true steroid-resistant disease, observational studies have suggested that a course of cyclosporine may sometimes induce remission or restore steroid responsiveness (grade D). Large retrospective studies in adults suggest that therapeutic response is slower than in children, but adults experience fewer relapses and more prolonged remission.