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Diagnosis: Minimal change disease, hypercellular variant

Diffuse mesangial hypercellularity is a well described microscopic change in some cases of idiopathic nephrotic syndrome. This histopathological pattern is thought to account for 2–10% of all patients with nephrotic syndrome. It has been described in some patients with minimal change nephrotic syndrome who frequently are steroid resistant or steroid dependent, and it has also been seen in association with focal segmental glomerulosclerosis (FSGS) or the deposition of mesangial IgM. Some authors suggested that mesangial hypercellularity (with or without IgM deposits) is a distinct entity, while others classified the lesion with minimal change disease (MCD). Others, however, believe that mesangial hypercellularity, minimal change disease and focal segmental glomerulosclerosis represent a continuum and that, over time, the first may convert to normal, MCD or FSGS (Alexopoulos E, et al. Adult-onset idiopathic nephrotic syndrome associated with pure diffuse mesangial hypercellularity. Nephrol Dial Transplant. 2000;15(7):981-7. [PubMed link] [Free full text])

It has been suggested that mesangial proliferative glomerulonephritis is a more severe form of MCD in which the initial injury is greater, leading to mesangial dysfunction and a slower rate of recovery (Kidney Int. 1981 Dec;20(6):765-71. [PubMed link])

See the Chapter Minimal Change Disease of our Tutorial.

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References

• Fujinaga S, Watanabe T, Endo A, Hirano D, Ohtomo Y, Shimizu T, Kaneko K. Transition of severe diffuse mesangial hypercellularity to minimal change disease in a child with steroid-resistant nephrotic syndrome. Clin Nephrol. 2011;76(6):504-6. [PubMed link]
• Alexopoulos E, Papagianni A, Stangou M, Pantzaki A, Papadimitriou M. Adult-onset idiopathic nephrotic syndrome associated with pure diffuse mesangial hypercellularity. Nephrol Dial Transplant. 2000;15(7):981-7. [PubMed link] [Free full text]
• Donia AF, Sobh MA, Moustafa FE, Bakr MA, Foda MA. Clinical significance and long-term evolution of minimal change histopathologic variants and of IGM nephropathy among Egyptians. J Nephrol. 2000;13(4):275-81. [PubMed link]
• Joh K, Matsuyama N, Kanetsuna Y, Usui N, Hattori M, Yumura W, Aizawa S. Nephrotic syndrome associated with diffuse mesangial hypercellularity: is it a heterogeneous disease entity? Am J Nephrol. 1998;18(3):214-20. [PubMed link]
• No authors listed. Primary nephrotic syndrome in children: clinical significance of histopathologic variants of minimal change and of diffuse mesangial hypercellularity. A Report of the International Study of Kidney Disease in Children. Kidney Int. 1981 Dec;20(6):765-71. [PubMed link]

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