In adults with nephrotic syndrome, which pattern is more common than minimal change disease in children?

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The key idea is that the typical cause of nephrotic syndrome shifts with age. Minimal change disease is by far the most common cause in children, and it usually responds very well to steroids. In adults, however, a different glomerular pattern becomes more common: focal segmental glomerulosclerosis. This pattern involves scarring in some nephrons and is often associated with podocyte injury; it tends to present with nephrotic-range proteinuria in adults and does not respond as predictably to steroids as in children. So, when comparing adults to pediatric presentations, focal segmental glomerulosclerosis is the pattern you’re more likely to see.