8. Nephrotic Syndrome 1 & 2 - Sakrani

• Proteinuria - urinary protein excretion of greater than 150 mg per day
• Advance renal disease - greater than 300 mg/24 h of albuminuria + frank proteinuria
• MCD is preceded by?

  upper respiratory tract infection
• MCD clinical presentation

  • urine protein excretion > 10 g in 24 = frothy urine
• MCD work up

  • urine = high protein
  • Metabolic panel - low total protein + low albumin + low Ca2+
• MCD - diagnosis

  • children - clinical
  • adult - kidney biopsy
• MCD - biopsy

  • microscopy - normal glomeruli with lipid accumulation in PCT (lipoid nephrosis)
  • electron microscopy - fusion of epithelial foot processes with lipid laden + no immune complex deposits
• *** MCD - treatment?

  prednisone
• FSGS seen in

  • HIV
  • IV heroin
  • associated with APOL1
• FSGS diagnosis

  • focal + segmental scarring most prominent in glomeruli - at corticomedullary junction
• FSGS tx

  • initially with high dose steroid
  • oral prednisone
  • people w/ high risk of steroid toxicity
  • calcineurin inhibitor + low dose prednisone
  • if resistant - calcineurin inhibitor - cyclo or tacro
• MGN or membranous nepropathy

  • primary is due to autoimmune - accumulation of PLA2R antigen
  • secondary - malignancy or infection
• MGN diagnostic work up

  • urinalysis - 3+ / 4+ proteinuria
  • primary - high PLA2R
• MGN has the highest incidence of renal

  • thrombosis
  • PE
  • DVT
• MGN biopsy

  • thickening of BM
  • spikes
  • diffuse granular deposit of IgG + C3
• MGN electron microscopy - subepithelial deposit along BM + effacement of podocyte foot processes
• What is recommended for MGN pts with prolonged proteinuria with absence of bleeding?

  anticoagulation
• What is the earliest detectable sign of diabetic nephropathy?

  microalbuminuria
• Microalbuminuria defined as

  • 30 to 300 mg of albumin per 24 hrs
  • associated with metabolic syndrome
  • insulin resistance
  • low HDL
  • high triglyceride
  • truncal obesity