Description of Minimal Change Nephrotic Syndrome, “Lipoid Nephrosis”

Shankar Prasad Yadav
B.P. Koirala Institute of Health Sciences, Nepal

The identification and description of each component of the clinical entity known as “nephrotic syndrome” have developed over centuries. Severe edema in children was described by Cornelius as far back as 1484, but he did not identify it as a kidney-related issue.1 Much later, in 1722, Theodore Zwinger postulated that this edema was related to pathological changes in the kidney.2 However, it was R. Bright (1827) and his contemporaries who demonstrated the presence of proteinuria and then proposed the triad of edema, diseased kidney, and proteinuria as defining the clinical syndrome. 3 Subsequently, the presence of elevated lipids in the blood of such patients was discovered by R. Christison.4

In 1905, the term “nephrosis”, coined by Friedrich Muller, was used to describe the pathological lesion of such patient as degenerative rather than inflammatory and hence replaced “nephritis”.5 In addition, Fritz Munk (1920) demonstrated lipid in the urine of such patients and reportedly used the term “lipoid nephrosis” to describe such conditions.6 During this period, in kidney specimens observed through optical microscopy in patients with nephrosis, the gross appearance of glomeruli seemed almost normal; therefore, the idea of “pure nephrosis”, or minimal change, emerged and it was conceded that the proteinuria resulted from tubular defect. The term “Nephrotic Syndrome” was gradually popularized in 1948.7

References

  1. Chadwick J, Mann WN. The medical works of Hippocrates. London: Oxford University Press, 1950: 228 (Section 2, No 136), 240 (Section 13, No 266), 244 (Section 7, No 34).
  2. Roelans C. Liber de aegritudinibus infantium. (c 1484). Reproduced in: Sudhoff KFJ. Erstlingeder padiatrischen Literatur. Munchen: Monchner Drucke, 1925: cxciii-cxciiii.
  3. Bright R. Reports of medical cases selected with a view of illustrating the symptoms and cure of diseases by reference to morbid anatomy. London: Longman Green, 1827. Vol 1.
  4. Christison R. On the cause of the milky and whey-like appearance sometimes observed in the blood. Edin Med Surg J 1830; 33: 274-280.
  5. Muller F. Morbus Brightii. Verhandl Deutsch Path Gesellsch 1905; 9: 64-99.
  6. Munk F. Klinische Diagnostik der degenerativen Nierenerkrankungen. Z Klin Med 1913; 78:1.52.
  7. Bradley SE, Tyson CJ. The 'nephrotic syndrome'. N Engl J Med 1948; 238: 223-227, 260-266.

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