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Difference between revisions of "Nephrotic syndrome"
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In children nephrotic syndrome is assumed to be ''minimal change disease''. Biopsies are done only there is no response to steriods. | In children nephrotic syndrome is assumed to be ''minimal change disease''. Biopsies are done only there is no response to steriods. | ||
=Clinical definition= | |||
Features: | |||
*Anasarca (whole body - edema). | |||
*Proteinuria (>3.5 g/24h). | |||
*Hypercholesterolemia. | |||
*Hypoalbuminemia. | |||
=Overview= | |||
Immune complex negative: | |||
#[[MCD]]. | |||
#[[FSGS]]. | |||
Immune complex positive: | |||
#[MN]]. | |||
#[[IgA nephropathy]]. | |||
=Specific entities= | |||
==Minimal change disease== | ==Minimal change disease== | ||
*Abbreviated ''MCD''. | |||
===General=== | ===General=== | ||
*Responds to steroids. | *Responds to steroids. | ||
*Most common cause of nephrotic syndrome in children. | |||
===Microscopic=== | ===Microscopic=== | ||
| Line 13: | Line 31: | ||
===EM=== | ===EM=== | ||
Features: | Features: | ||
Diffuse loss of foot processes. | *Diffuse loss of foot processes. | ||
Note: | |||
*Foot processes on urinary space side. | |||
Image: | Image: | ||
| Line 19: | Line 40: | ||
==Focal segmental glomerulosclerosis== | ==Focal segmental glomerulosclerosis== | ||
*Abbreviated ''FSGS''. | |||
===General=== | ===General=== | ||
*Presents as nephrotic syndrome. | *Presents as nephrotic syndrome. | ||
*Does not respond to steroids (unlike MCD). | *Does not respond to steroids (unlike MCD). | ||
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====Histologic classification==== | ====Histologic classification==== | ||
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> | 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> | ||
{| class="wikitable" | |||
!Subtype | |||
!Comment | |||
|- | |||
|Cellular | |||
|abrupt severe onset | |||
|- | |||
|Collapsing | |||
|poor prognosis, viral/toxic etiology | |||
|- | |||
|Tip lesion | |||
|good prognosis | |||
|- | |||
|Perihilar | |||
|reduced renal mass | |||
|- | |||
|Not otherwise specified (NOS) | |||
|most common | |||
|} | |||
===Stains=== | ===Stains=== | ||
| Line 95: | Line 130: | ||
*[http://commons.wikimedia.org/wiki/File:Membranous_Nephropathy_Pathology_Diagram.svg MN - schematic (WC)]. | *[http://commons.wikimedia.org/wiki/File:Membranous_Nephropathy_Pathology_Diagram.svg MN - schematic (WC)]. | ||
=See also= | |||
*[[Medical kidney diseases]]. | *[[Medical kidney diseases]]. | ||
*[[Kidney tumours]]. | *[[Kidney tumours]]. | ||
=References= | |||
{{Reflist| | {{Reflist|2}} | ||
[[Category:Genitourinary pathology]] | [[Category:Genitourinary pathology]] | ||