MESANGIAL IGG IN CHILDHOOD MINIMAL CHANGE DISEASE - CLINICAL RELEVANCE

The clinical courses of five children with the nephrotic syndrome and renal biopsies diagnosed as minimal change disease (MCD) by light micr oscopy but with mesangial immune deposits of IgG (greater-than-or-equa l-to 2+) and no dominant or codominant IgA were reviewed retrospective ly to determine if the presence of significant mesangial deposits of I gG has prognostic implications and to evaluate the treatment these pat ients received. All five of the children were steroid dependent or res istant initially, and four received cyclosporine or cytotoxic agents l ater. After a mean follow-up period of 2.9 years for four and 20 years for one, all are in remission. All have normal renal function with no hypertension. These results suggest that the deposition of IgG in the mesangium of biopsies from patients with MCD by light microscopy may predict a more difficult course initially and may require more aggress ive treatment to achieve permanent remission.