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Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice
Published on: June 8, 2022
Minimal mesangial lupus nephritis: a systematic review
1Department of Medicine, Tuen Mun Hospital and Centre for Assessment and Treatment of Rheumatic Diseases, Pok Oi Hospital, Hong Kong, China. ccmok2005@yahoo.com
Objectives:
To summarize the clinical presentation, histological features, treatment, and outcome of minimal change nephropathy (MCN) in patients with systemic lupus erythematosus (SLE).
Methods:
We performed a systematic review of cases of MCN in SLE patients reported in the English literature from January 1985 to May 2009 by a Medline search.
Results:
The estimated prevalence of MCN in biopsy-proven lupus nephritis is 2.3% in childhood and 1.1% in adults. There are 13 individual cases (12 women, one man) of SLE-related MCN reported in the literature. The mean age of nephritis onset was 32.7 years. In six (46%) patients, MCN was the initial manifestation of SLE. All patients presented with nephrotic syndrome and two (15%) had active urinary sediments. Renal function was impaired in eight (62%) patients and six (46%) patients had active lupus serology. All patients responded promptly to high-dose glucocorticoids but four (31%) had relapse of proteinuria during their course of SLE. None of the patients developed thromboembolic or infective complications.
Conclusions:
MCN is an uncommon histological class of lupus nephritis. Typically, patients present with heavy proteinuria, and transient renal dysfunction is common. The prognosis of MCN in SLE appears to be good because of its rapid response to glucocorticoids. Relapses of proteinuria may be reduced by the use of maintenance immunosuppression. Alkylating agents, calcineurin inhibitors, mycophenolate mofetil, and rituximab can be considered in glucocorticoid-dependent or refractory cases of SLE-related MCN.
Insights
Minimal change nephropathy (MCN) in systemic lupus erythematosus (SLE) is rare, presenting with heavy proteinuria and often transient kidney dysfunction. Patients typically respond well to glucocorticoids, suggesting a good prognosis for MCN in SLE.
Area of Science:
- Nephrology
- Rheumatology
- Pathology
Background:
- Minimal change nephropathy (MCN) is an uncommon histological finding in lupus nephritis.
- Systemic lupus erythematosus (SLE) can present with various renal manifestations, including MCN.
Purpose of the Study:
- To summarize the clinical presentation, histological features, treatment, and outcomes of MCN in SLE patients.
- To review the current literature on MCN associated with SLE.
Main Methods:
- A systematic review of English-language literature from January 1985 to May 2009 was conducted using Medline.
- Case reports of MCN in SLE patients were analyzed.
Main Results:
- MCN prevalence in lupus nephritis is estimated at 2.3% in children and 1.1% in adults.
- Thirteen cases of SLE-related MCN were identified, predominantly in women, with a mean onset age of 32.7 years.
- Most patients presented with nephrotic syndrome; renal function was often impaired, and lupus serology was frequently active. All patients responded to glucocorticoids, though relapses occurred in 31%.
Conclusions:
- MCN is an uncommon cause of lupus nephritis, typically characterized by heavy proteinuria and often transient renal dysfunction.
- The prognosis for MCN in SLE is generally favorable due to prompt response to glucocorticoids.
- Maintenance immunosuppression may reduce proteinuria relapses; alternative agents are options for refractory cases.
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