Does minimal change disease (MCD) cause hyperlipidemia?

From the Guidelines

Minimal change disease can cause hyperlipidemia as a secondary effect of the nephrotic syndrome that typically accompanies it. This occurs due to the kidneys leaking large amounts of protein into the urine, leading to hypoalbuminemia, which in turn causes the liver to increase production of lipoproteins, resulting in elevated cholesterol and triglyceride levels in the blood 1. The hyperlipidemia in minimal change disease is usually temporary and resolves when the underlying nephrotic syndrome is treated, typically with corticosteroids.

Key Points to Consider

• The nephrotic syndrome associated with minimal change disease leads to hypoalbuminemia, which triggers an increase in lipoprotein production by the liver.
• The hyperlipidemia is a secondary effect and typically resolves with treatment of the underlying condition.
• Treatment of hyperlipidemia in the setting of new-onset minimal change disease may not be necessary if there is rapid resolution of the syndrome with therapy, as suggested by the commentary on the 2012 KDIGO clinical practice guideline for glomerulonephritis 1.
• The decision to institute lipid-lowering therapy should consider the pace of resolution of proteinuria and the overall cardiovascular risk profile of the patient.

Management Considerations

• The primary focus is on treating the underlying minimal change disease to resolve the nephrotic syndrome.
• Corticosteroids are the mainstay of treatment for minimal change disease.
• Lipid-lowering medications may be considered in cases of persistent nephrotic syndrome and hyperlipidemia, especially if cholesterol levels are severely elevated or if the patient has other cardiovascular risk factors.

From the Research

Minimal Change Disease and Hyperlipidemia

• Minimal change disease (MCD) is a histopathological lesion in the kidney that is most commonly associated with nephrotic syndrome, which can lead to hyperlipidemia 2.
• The pathogenesis of MCD is not well understood, but it is thought to be related to immunologic dysregulation and modifications of the podocyte, leading to massive proteinuria and hypercholesterolemia 3, 4.
• Hyperlipidemia is a common complication of MCD, resulting from the massive proteinuria and hypoalbuminemia that characterize the disease 2, 4.
• The treatment of MCD typically involves the use of corticosteroids, which can help to reduce proteinuria and hyperlipidemia, but may not completely eliminate the risk of hyperlipidemia 2, 3.

Hyperlipidemia Treatment

• The treatment of hyperlipidemia in patients with MCD may involve the use of statins or other lipid-lowering agents, although the evidence for the use of these agents in this population is limited 5.
• The use of statins to treat hyperlipidemia has been widely accepted and recommended in adults with at least one risk factor and a calculated 10-year cardiovascular disease risk of 10%, but may be associated with side effects such as myalgias and liver injury 5.

Relationship between MCD and Hyperlipidemia

• There is evidence to suggest that MCD can cause hyperlipidemia, due to the massive proteinuria and hypoalbuminemia that characterize the disease 2, 4.
• The exact mechanisms by which MCD leads to hyperlipidemia are not fully understood, but are thought to involve immunologic dysregulation and modifications of the podocyte 3, 4.