Minimal change disease and focal segmental glomerulosclerosis

Minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) are among the most common causes of nephrotic syndrome. Histologically both diseases are defined as podocytopathies characterized by the fusion of podocyte foot processes which are visible under electron microscopy. While the exact pathogenesis was unclear for a long time, accumulating evidence suggests that anti-nephrin antibodies play a central role in many cases of MCD. The genesis of FSGS is complex. The disease is characterized by the irreversible loss of podocytes and a resulting focal sclerosis in the glomerulus. The differentiation between primary, secondary and genetic forms of these diseases is crucial for the selection of treatment as only primary forms generally require immunosuppression. Several therapeutic approaches are available for treatment, including steroids, calcineurin inhibitors (CNI), such as tacrolimus and mycophenolate mofetil (MMF). The FSGS and MCD differ in their response rates to treatment, with FSGS generally having a poorer prognosis. In the future, targeted therapies will gain increasing importance, especially in genetically related variants of FSGS. Overall, the treatment of MCD and FSGS remains a challenge and requires a customized and carefully coordinated treatment based on individual patient characteristics.