Question

Which of the following is the true statement regarding minimal change disease?

• A. Loss of foot processes
• B. Antigen-antibody complexes
• C. Loss of foot processes along with loss of charge across the membrane, hence leading to proteinuria
• D. Destruction of the glomerulus, with minimal tissue only remaining intact

Hint:

MCD proteinuria comes from foot process effacement plus loss of the glomerular basement membrane's negative charge barrier.

Answer 1

The Correct Option is C

Minimal change disease gets its name because the glomeruli look almost normal under a light microscope, yet the patient still has heavy proteinuria. The real damage only shows up on electron microscopy.

1. Loss of foot processes: True but incomplete on its own, since it does not explain why protein specifically leaks out.
2. Antigen-antibody complexes: Wrong for MCD. Immunofluorescence is negative here; immune complex deposits belong to diseases like membranous nephropathy.
3. Loss of foot processes along with loss of charge across the membrane, causing proteinuria: This is the complete and correct mechanism. Podocyte foot process effacement plus loss of the membrane's anionic (negative charge) barrier lets albumin cross into the urine.
4. Destruction of the glomerulus, with minimal tissue remaining: This describes severe glomerular scarring, not MCD, where the glomerulus stays structurally intact.

Put simply, MCD proteinuria comes from a double hit: the podocyte's foot processes flatten out, and the membrane loses the negative charge that normally repels albumin.

Let's summarize:

• Light microscopy is normal in MCD; the lesion is seen only on electron microscopy.
• Foot process loss plus charge barrier loss together explain the selective proteinuria.

The correct statement is option (C): loss of foot processes with loss of membrane charge, leading to proteinuria.