<prompt> A 7 year old girl is brought with complaints of generalized swelling of the body.Urinary examination reveals Grade 3 proteinuria and the presence of hyaline and fatty casts.She has no history of Hematuria.Which of the following statements about her condition is true:No IgG deposits or C3 deposition on Renal biopsyHer C3 levels will be lowIgA Nephropathy is the likely diagnosisAlpos syndrome is the likely diagnosis  <response>: Answer is A No IgG Deposits or C3 deposition on Renal biopsyThe presence of generalized edema significant proteinuria and absence of hematuria in a young 7 year old girl suggests a diagnosis of Nephrotic syndrome. Minimal change disease Lipoid nephrosis is the commonest cause of Nephrotic syndrome in children and is the most likely diagnosis of the patient in question.Minimal chance disease is characterized by absence of IgG deposits and or complement on immunofluorescence biopsy specimen and is therefore the single best answer of choice.IRA Nephropathy and Alpos syndrome characteristically present with an Acute Nephritic syndrome with recurrent gross hematuria.The patient in question has no hematuria and hence these diagnosis can be excluded. Serum complement C3 levels are characteristically normal in Minimal change diseaseThe Patient in question is a case of Minimal change disease because:Age of PatientPeak age of onset of Minimal change disease is 6 - 8 yearsPresenting symptomsPeripheral edema Generalized edema is the characteristic presenting feature of minimal change disease.Hematuria is uncommon in Minimal change diseaseLaboratory FeaturesProteinuria Nephrotic range is characteristicHyaline casts and Fatty casts may be seen in minimal change disease.Occasional Hyaline casts and Fatty casts may be seen in Minimal change diseaseHyaline CastsHyaline casts are composed almost exclusively of protein alone and they pass almost unchanged down the urinary tractSmall number of these casts may be seen in normal urine and in any condition associated with proteinuria including Minimal change diseaseThese casts carry no attached significance and do not necessarily imply an underlying renal diseaseFatty CastsFatty casts are a special type of cellular cast associated with fatty degeneration of tubular epitheliumThese casts are composed of fatty droplets and proteinPresence of these casts suggests a disease associated with nephrotic syndrome such as primary lipoid nephrosis minimal change or nephrosis secondary to Diabetes, SLE, amyloidosis etc.Minimal change Disease: ReviewMost common cause of Nephrotic syndrome in children 80 in children; 20 in adultsPeak Age of onset is between 6-8 years of Age usually 10 yearsType of onset : InsidiousClinical featuresPeripheral Edema: Presenting FeatureHematuria : Uncommon may be seen in 20-30 of patientsHypeension V. RareNephrotic syndrome is the typical presentationPeripheral edema is the hallmark of Nephrotic syndrome occurring when serum albumin levels become less than 3gdlInitially dependent Edema Generalized edema May develop Pleural effusion, pulmonary edema, ascitisLaboratory Features of Nephrotic syndromeProteinuriaHypoalbuminemiaHyperlipidemiaHyper cholesterolemia Increased hepatic production of lipidsHypercoagulabilnySerum Complement C3 levels are NormalRenal pathology BiopsyInvestigationLight microscopy QElectron microscopy QlmmunofluorescenceQObservationNo abnormality hence the term minimal changeFusion of foot processesAbsence of immunoglobulin or complemenNo immunoglobulin deposit IgG are seen as Renal biopsyPrognosisPrognosis is GoodResponse to steroids is ExcellentDoes not progress to Renal FailureTreatmentsCoieosteroids form the mainstay for treatment of MCD 