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| =Nephrotic syndrome= | | =Nephrotic syndrome= |
| In children nephrotic syndrome is assumed to be ''minimal change disease''. Biopsies are done only there is no response to steriods.
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| ==Minimal change disease==
| | This includes the following: |
| ===General===
| | *[[Minimal change disease]]. |
| *Responds to steroids.
| | *[[Focal segmental glomerulosclerosis]]. |
| | | *[[Membranous nephropathy]]. |
| ===Microscopic===
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| Features:
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| *No changes on light microscopy.
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| | |
| ===EM===
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| Features:
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| Diffuse loss of foot processes.
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| Image:
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| *[http://commons.wikimedia.org/wiki/File:Minimal_Change_Disease_Pathology_Diagram.svg MCD - schematic (WC)]. | |
| | |
| ==Focal segmental glomerulosclerosis==
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| ===General===
| |
| *Abbreviated ''FSGS''.
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| *Presents as nephrotic syndrome.
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| *Does not respond to steroids (unlike MCD).
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| | |
| ====Etiology====
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| *Primary.
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| **May be familial.<ref name=pmid12778884>{{cite journal |author=Sánchez de la Nieta MD, Arias LF, Alcázar R, ''et al.'' |title=[Familial focal and segmentary hyalinosis] |language=Spanish; Castilian |journal=Nefrologia |volume=23 |issue=2 |pages=172–6 |year=2003 |pmid=12778884 |doi= |url=}}</ref>
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| *Secondary.<ref>URL: [http://www.kidneypathology.com/English_version/Focal_segmental_GS.html http://www.kidneypathology.com/English_version/Focal_segmental_GS.html]. Accessed on: 11 February 2011.</ref>
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| **HIV.
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| **Drug use.
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| **Reduced renal mass.
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| Primary vs. secondary:<ref name=pmid12704572>{{Cite journal | last1 = D'Agati | first1 = V. | title = Pathologic classification of focal segmental glomerulosclerosis. | journal = Semin Nephrol | volume = 23 | issue = 2 | pages = 117-34 | month = Mar | year = 2003 | doi = 10.1053/snep.2003.50012 | PMID = 12704572 }}
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| </ref>
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| {| class="wikitable"
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| | '''Feature'''
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| | '''Primary'''
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| | '''Secondary'''
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| |-
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| | Proteinuria (onset)
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| | sudden
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| | progressive
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| |-
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| | Albumnin
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| | low
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| | normal
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| |-
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| | Glomerulus size
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| | normal
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| | increased
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| |-
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| | Foot process effacement
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| | diffuse
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| | mild
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| |}
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| ===Microscopic===
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| Features:
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| *Partial sclerosis of less than 50% of glomeruli.
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| Image:
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| *[http://library.med.utah.edu/WebPath/jpeg1/RENAL083.jpg FSGS (utah.edu)]. | |
| | |
| ====Histologic classification====
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| FSGS can be subdivided into the following subgroups:<ref name=pmid16518352>{{Cite journal | last1 = Thomas | first1 = DB. | last2 = Franceschini | first2 = N. | last3 = Hogan | first3 = SL. | last4 = Ten Holder | first4 = S. | last5 = Jennette | first5 = CE. | last6 = Falk | first6 = RJ. | last7 = Jennette | first7 = JC. | title = Clinical and pathologic characteristics of focal segmental glomerulosclerosis pathologic variants. | journal = Kidney Int | volume = 69 | issue = 5 | pages = 920-6 | month = Mar | year = 2006 | doi = 10.1038/sj.ki.5000160 | PMID = 16518352 }}</ref>
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| *Cellular.
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| *Collapsing - poor prognosis.
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| *Tip lesion - good prognosis.
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| *Perihilar.
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| *Not otherwise specified (NOS) - most common.
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| | |
| ===Stains===
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| Features:<ref>URL: [http://www.kidneypathology.com/English_version/Focal_segmental_GS.html http://www.kidneypathology.com/English_version/Focal_segmental_GS.html]. Accessed on: 11 February 2011.</ref>
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| *PAS +ve crescents.
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| ==Membranous nephropathy==
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| ===General===
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| *[[AKA]] ''membranous glomerulonephritis''.
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| *Presents as nephrotic syndrome.
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| | |
| Clinical DDx:<ref>{{Ref Klatt|241}}</ref>
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| *Hepatitis B.
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| *Hepatitis C.
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| *Carcinoma.
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| *NSAID toxicity.
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| *SLE.
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| *Idiopathic.
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| ===Microscopic===
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| Features:
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| *Subepithelial immune complex depositions, spike forming.
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| Image:
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| *[http://commons.wikimedia.org/wiki/File:Membranous_Nephropathy_Pathology_Diagram.svg MN - schematic (WC)].
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| =Mixed nephrotic and nephritic= | | =Mixed nephrotic and nephritic= |