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Difference between revisions of "Nephrotic syndrome"
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'''Nephrotic syndrome''' is a constellation of clinical findings seen in a number of [[medical kidney diseases]]. This article deals with them. | '''Nephrotic syndrome''' is a constellation of clinical findings seen in a number of [[medical kidney diseases]]. This article deals with them. It should '''not''' be confused with ''[[nephritic syndrome]]'' which has an almost identical spelling. | ||
In children nephrotic syndrome is assumed to be ''minimal change disease''. Biopsies are done only there is no response to | An introduction to the medical kidney is in the ''[[medical kidney diseases]]'' article. In children nephrotic syndrome is assumed to be ''minimal change disease''. Biopsies are done only there is no response to steroids. | ||
=Clinical definition= | =Clinical definition= | ||
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Immune complex positive: | Immune complex positive: | ||
#[[MN]]. | #[[MN]]. | ||
#[[IgA nephropathy]]. | #[[IgA nephropathy]].<ref name=pmid7849391>{{Cite journal | last1 = Komatsuda | first1 = A. | last2 = Wakui | first2 = H. | last3 = Yasuda | first3 = T. | last4 = Imai | first4 = H. | last5 = Miura | first5 = AB. | last6 = Tsuda | first6 = A. | last7 = Nakamoto | first7 = Y. | title = Successful delivery in a pregnant women with crescentic IgA nephropathy. | journal = Intern Med | volume = 33 | issue = 11 | pages = 723-6 | month = Nov | year = 1994 | doi = | PMID = 7849391 }}</ref><ref name=pmid22322610>{{Cite journal | last1 = Kim | first1 = JK. | last2 = Kim | first2 = JH. | last3 = Lee | first3 = SC. | last4 = Kang | first4 = EW. | last5 = Chang | first5 = TI. | last6 = Moon | first6 = SJ. | last7 = Yoon | first7 = SY. | last8 = Yoo | first8 = TH. | last9 = Kang | first9 = SW. | title = Clinical features and outcomes of IgA nephropathy with nephrotic syndrome. | journal = Clin J Am Soc Nephrol | volume = 7 | issue = 3 | pages = 427-36 | month = Mar | year = 2012 | doi = 10.2215/CJN.04820511 | PMID = 22322610 }}</ref> | ||
Other: | |||
*Pre-eclampsia.<ref name=pmid20033418>{{Cite journal | last1 = Wei | first1 = Q. | last2 = Zhang | first2 = L. | last3 = Liu | first3 = X. | title = Outcome of severe preeclampsia manifested as nephrotic syndrome. | journal = Arch Gynecol Obstet | volume = 283 | issue = 2 | pages = 201-4 | month = Feb | year = 2011 | doi = 10.1007/s00404-009-1338-z | PMID = 20033418 }}</ref> | |||
=Specific entities= | =Specific entities= | ||
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===General=== | ===General=== | ||
*Presents as nephrotic syndrome. | *Presents as nephrotic syndrome. | ||
*Does not respond to steroids (unlike MCD). | *Does not respond to steroids (unlike [[MCD]]). | ||
*Usually less rapid onset than MCD. | *Usually less rapid onset than MCD. | ||
** | **Fibrosis usually takes some time. | ||
====Etiology==== | ====Etiology==== | ||
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===General=== | ===General=== | ||
*Presents as nephrotic syndrome. | *Presents as [[nephrotic syndrome]]. | ||
*Variable course. | *Variable course. | ||
*Pathogenesis: autoantibodies directed against ''phospholipase A2 receptor 1'', abbreviated PLA2R.<ref name=pmid22388552>{{Cite journal | last1 = Glassock | first1 = RJ. | title = The pathogenesis of membranous nephropathy: evolution and revolution. | journal = Curr Opin Nephrol Hypertens | volume = | issue = | pages = | month = Mar | year = 2012 | doi = 10.1097/MNH.0b013e3283522ea8 | PMID = 22388552 }}</ref><ref name=omim604939>{{OMIM|604939}}</ref> | *Pathogenesis: autoantibodies directed against ''phospholipase A2 receptor 1'', abbreviated PLA2R.<ref name=pmid22388552>{{Cite journal | last1 = Glassock | first1 = RJ. | title = The pathogenesis of membranous nephropathy: evolution and revolution. | journal = Curr Opin Nephrol Hypertens | volume = | issue = | pages = | month = Mar | year = 2012 | doi = 10.1097/MNH.0b013e3283522ea8 | PMID = 22388552 }}</ref><ref name=omim604939>{{OMIM|604939}}</ref> | ||
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*Nephr'''o'''tic syndrome (caused by) '''a'''utoimmune disorders, hepatitis '''B''', '''c'''ancer, '''d'''rugs (with), sub'''e'''pithelial deposits & '''s'''pikes. | *Nephr'''o'''tic syndrome (caused by) '''a'''utoimmune disorders, hepatitis '''B''', '''c'''ancer, '''d'''rugs (with), sub'''e'''pithelial deposits & '''s'''pikes. | ||
Images | ====Images==== | ||
www: | |||
*[http://www.flickr.com/photos/jian-hua_qiao_md/3989875091/in/set-72157622411941607 MN - silver stain (flickr.com)]. | |||
<gallery> | |||
Image:Membranous_nephropathy_-_he_-_very_high_mag.jpg | MN - very high mag. (WC) | |||
Image:Membranous_nephropathy_-_pas_-_very_high_mag.jpg | MN - PAS - very high mag. (WC) | |||
Image:Membranous_nephropathy_-_mpas_-_very_high_mag.jpg | MN - MPAS - very high mag. (WC) | |||
Image:Membranous_nephropathy_-_cropped_-_mpas_-_very_high_mag.jpg | MN - MPAS - very high mag. (WC) | |||
</gallery> | |||
===IF=== | ===IF=== | ||