Nephrotic Syndrome

Proteinuria (>3.5g in 24hrs, PCR>300), Hypoalbuminaemia (<30g/L), Oedema (albumin loss -> reduced oncotic pressure -> oedema, effusions, ascites)

Can cause:

• hypercholesterolaemia (increased synthesis of proteins, including lipoproteins)
• hypercoagulability/thrombosis (loss on antithrombin III)
• infection (loss of Ig)
• malnutrition/growth failure (loss of protein)
• renal failure

Commonest cause of nephrotic syndrome in children

Causes foamy urine and oedema

Can be secondary to NSAIDs, Hodgkin's lymphoma, atopy

Steroid responsive, no long-term damage

Light microscopy: minimal change

Electron microscopy: podocyte effacement

Commonest PRIMARY cause of nephrotic syndrome in adults

Scarring of part of the glomerulus in some glomeruli

Causes nephrotic syndrome and renal impariment

Associated with: HIV, heroin use

Immune complex formation in sub-endothelium damaging podocytes- GBM thickening in spike and dome pattern

Mostly idiopathic (85%) but can be secondary: cancers, hepatitis, SLE, gold/penicillamine

Can cause CKD

Commonest cause opf adult nephrotic syndrome and end-stage renal failure.

Causes albuminuria, HTN, renal insufficiency- can progress to nephrotic syndrome

Kidneys initially swell then shrink

Immune complexes from chronic infection (e.g. Hep C) deposit in sub-endothelium

Causes GBM thickening + mesangial cell proliferation

Associated with hep C, SLE, cryoglobulinaemia

Borderline nephritic/nephrotic syndrome