Nephrotic Syndrome: MINIMAL CHANGE DISEASE, MEMBRANOUS
NEPHROPATHY
What is the significance of nephrotic-range Hypertensive nephrosclerosis,
proteinuria?- It is almost invariably atherosclerotic disease, chronic interstitial
associated with glomerular disease nephropathy, orthostatic proteinuria
Primary glomerular diseases vs. secondary Why is a renal biopsy generally not useful in
glomerular diseases?- 1. Primary evaluating patients with proteinuria of <3 g/d?-
glomerular diseases mean that the condition Nonnephrotic proteinuria is often
occurs on its own, without another known associated with tubulointerstitial disease.
systemic disease such as lupus or diabetes e.g. Findings on biopsy are nonspecific and unlikely
*minimal change*, *membranous nephropathy*, to provide enough information to make a
*focal segmental glomerulosclerosis (FSGS)*, diagnosis.
and medication-induced glomerulopathy (e.g.,
NSAIDs, heroin) In general, what is the prognosis in patients with
2. Secondary glomerular diseases are kidney <3 g/d proteinuria?- The prognosis is
conditions with glomerular pathology in which an usually good in these patients.
underlying cause can be established e.g. DM
type 1 or 2, collagen vascular disease, What is the typical clinical presentation of
malignancy-associated renal disease, infection- minimal change disease?- Edema, ascites
associated glomerulopathy (e.g., hepatitis B or C, in a child younger than 10 years; and onset over
HIV) days to weeks. The distribution is bimodal, and
minimal change disease can also affect elderly
What laboratory studies may be useful in the patients.
evaluation of a patient with nephrotic syndrome?-
Chemistry panel, LFTs, glycosylated How common is minimal change disease?-
hemoglobin, ANA, ANCA, serum complement Accounts for approximately 90% of
studies, hepatitis panel, HIV antibodies, serum nephrotic syndrome in children aged <10 years;
cryoglobulins, ESR, RF, SPEP, and UPEP accounts for approximately 20% of nephrotic
syndrome in adults
How is a renal biopsy useful in evaluating a
patient with nephrotic syndrome?- LM, IF, What are the most common secondary causes of
and EM of glomerular tissue combined with minimal change disease?-
clinical information provide a diagnosis, useful for Lymphoproliferative disease, especially
management and prognosis. Hodgkin's lymphoma, and NSAID use
What are the complications of the nephrotic What are the characteristic laboratory findings?-
syndrome?- Edema and ascites, skin Normal renal function, marked proteinuria,
breakdown, hypercoagulability, hyperlipidemia hyperlipidemia, hypoalbuminemia, and urinary
and accelerated atherosclerosis, immunoglobulin sediment with hyaline casts and oval fat bodies
loss, and predisposition to bacterial infection.
Heavy proteinuria itself may also accelerate the What are the renal biopsy characteristics for LM?
course of renal failure.
Normal IF? Negative EM?- LM - Normal
Normal IF - Negative
What are the most common causes of
EM - Effacement of foot processes
nonnephrotic proteinuria (<3 g/d)?-
1/3
NEPHROPATHY
What is the significance of nephrotic-range Hypertensive nephrosclerosis,
proteinuria?- It is almost invariably atherosclerotic disease, chronic interstitial
associated with glomerular disease nephropathy, orthostatic proteinuria
Primary glomerular diseases vs. secondary Why is a renal biopsy generally not useful in
glomerular diseases?- 1. Primary evaluating patients with proteinuria of <3 g/d?-
glomerular diseases mean that the condition Nonnephrotic proteinuria is often
occurs on its own, without another known associated with tubulointerstitial disease.
systemic disease such as lupus or diabetes e.g. Findings on biopsy are nonspecific and unlikely
*minimal change*, *membranous nephropathy*, to provide enough information to make a
*focal segmental glomerulosclerosis (FSGS)*, diagnosis.
and medication-induced glomerulopathy (e.g.,
NSAIDs, heroin) In general, what is the prognosis in patients with
2. Secondary glomerular diseases are kidney <3 g/d proteinuria?- The prognosis is
conditions with glomerular pathology in which an usually good in these patients.
underlying cause can be established e.g. DM
type 1 or 2, collagen vascular disease, What is the typical clinical presentation of
malignancy-associated renal disease, infection- minimal change disease?- Edema, ascites
associated glomerulopathy (e.g., hepatitis B or C, in a child younger than 10 years; and onset over
HIV) days to weeks. The distribution is bimodal, and
minimal change disease can also affect elderly
What laboratory studies may be useful in the patients.
evaluation of a patient with nephrotic syndrome?-
Chemistry panel, LFTs, glycosylated How common is minimal change disease?-
hemoglobin, ANA, ANCA, serum complement Accounts for approximately 90% of
studies, hepatitis panel, HIV antibodies, serum nephrotic syndrome in children aged <10 years;
cryoglobulins, ESR, RF, SPEP, and UPEP accounts for approximately 20% of nephrotic
syndrome in adults
How is a renal biopsy useful in evaluating a
patient with nephrotic syndrome?- LM, IF, What are the most common secondary causes of
and EM of glomerular tissue combined with minimal change disease?-
clinical information provide a diagnosis, useful for Lymphoproliferative disease, especially
management and prognosis. Hodgkin's lymphoma, and NSAID use
What are the complications of the nephrotic What are the characteristic laboratory findings?-
syndrome?- Edema and ascites, skin Normal renal function, marked proteinuria,
breakdown, hypercoagulability, hyperlipidemia hyperlipidemia, hypoalbuminemia, and urinary
and accelerated atherosclerosis, immunoglobulin sediment with hyaline casts and oval fat bodies
loss, and predisposition to bacterial infection.
Heavy proteinuria itself may also accelerate the What are the renal biopsy characteristics for LM?
course of renal failure.
Normal IF? Negative EM?- LM - Normal
Normal IF - Negative
What are the most common causes of
EM - Effacement of foot processes
nonnephrotic proteinuria (<3 g/d)?-
1/3
