A kidney biopsy is not routinely performed as soon as the nephrotic syndrome is found in lab work-up. According to the National Kidney Foundation (NKF) Kidney Disease – Improve Global Outcomes (KDIGO) guidelines in 2012, an initial attempt using corticosteroids should be performed before a renal biopsy is performed. Electron microscopy is required for the diagnosis of minimal change disease. It shows effacement (fusion) of podocytes, which are visceral epithelial cells, with slit-pore membrane obliteration between podocyte foot processes. However, podocyte effacement is not specific and should not be considered pathognomonic of the disease.

• Effacement of foot processes is seen in minimal change disease on electron microscopy and this is the only morphologic feature of minimal change disease on electron microscopy.^[1][2][3]