Nephrotic syndrome
From IDWiki
Definition
- Syndrome characterized by:
- Significant proteinuria > 3g/day
- Hyperlipidemia/lipiduria
- Anasarca
- Hypoalbuminemia <35g/L
Differential Diagnosis
- Non-proliferative glomerulonephritis
- Minimal change disease
- Primary
- Drugs
- NSAIDs and COX-2 inhibitors
- Ampicillin, rifampicin, cephalosporins
- Lithium
- D-penicillamine and tiopronin
- Pamidronate
- Sulfasalazine and 5-ASAs
- Interferon-gamma
- Neosplasms
- Hodgkin lymphoma
- Non-Hodgkin lymphoma
- Leukemia
- Lupus nephritis V (membranous nephritis)
- Focal segmental glomerulosclerosis
- Primary
- Severe obesity and other hyperfiltration syndromes
- Infections
- HIV
- Parvovirus B19
- CMV
- EBV
- Drugs
- Heroin
- Interferons
- Pamidronate
- Anabolic steroids
- mTOR inhibitos
- Calcineurin inhibitos
- Anthracyclines
- Lithium
- Other
- Sickle cell anemia
- Thrombotic microangiopathy
- Genetic disorders
- Membranous nephropathy
- Primary
- Lupus
- Drugs
- Gold
- Penicillamine
- NSAIDs
- Infections
- Hepatitis B and C
- Malaria
- Syphilis
- Neoplasms
- Non-Hodgkin lymphoma
- Solid cancers
- IgG4 disease
- Minimal change disease
Most common causes
- Membranous nephropathy (24 percent)
- Minimal change disease (16 percent)
- Lupus (14 percent)
- FSGS (12 percent): more common in black patients
- Amyloidosis (6 to 17 percent): more common in older patients
- Membranoproliferative glomerulonephritis (7 percent)
- IgA nephropathy (6 percent)
Epidemiology
- If < 20 years old
- Minimal change (70%)
- Membranous (20%)
- Focal segmental glomerulosclerosis (10%)
- If > 20 years old
- Membranous (70%)
- Minimal change (20%)
- Focal segmental glomerulosclerosis (10%)
Management
- If < 20 years old
- Treat empirically with steroids, as the majority are primary minimal change disease
- If > 20 years old
- Needs kidney biopsy to direct treatment