Management of minimal lesion glomerulonephritis: Evidence-based recommendations

The treatment of idiopathic minimal lesion disease in children has been ext ensively studied in randomized controlled trials, however, there is less in formation available for adults. This article summarizes evidence-based reco mmendations for management. The first attack should be treated with prednis one or prednisolone at 60 mg/m(2) per day (up to a maximum of 80 mg/day) fo r four to six weeks, followed by 40 mg/m(2) of prednisone every other day f or another four to six weeks (grade A). Relapse should be treated with 60 m g/m(2)/day of prednisone (up to SO mg/day) only until the urine becomes pro tein free for three days, and then an alternate day regimen of 40 mg/m(2) s hould be used for another month (grade A). Patients with frequently relapsi ng disease will have a significant reduction in relapse frequency after eig ht weeks of an alkylating agent (grade A). Less rigorous studies have sugge sted benefit with long-term, alternate-day corticosteroid (grade D) or the antihelminthic agent levamisole (grade D). For patients with steroid-depend ent disease, an 8- or 12-week course with cyclophosphamide can induce remis sion (grade D). In true steroid-resistant disease, observational studies ha ve suggested that a course of cyclosporine may sometimes induce remission o r restore steroid responsiveness (grade D). Large retrospective studies in adults suggest that therapeutic response is slower than in children, but ad ults experience fewer relapses and more prolonged remission.