What are the 3 primary glomerular diseases that cause nephrotic syndrome, and name 3 secondary causes of each?
The term nephrotic syndrome refers to a distinct constellation of clinical and laboratory features of renal disease. It is specifically defined by the presence of:
- Heavy proteinuria (>3.5 g/24 hours)
- Hypoalbuminemia
- Peripheral edema
- Hyperlipidemia
Thrombotic disease may also be observed.
The classification is based on pathological findings:
- minimal change disease
- focal segmental sclerosis (FSGS)
- membranous nephropathy
Sometimes there can be associated secondary diseases that may be causative in nature.
Minimal change:
- Drugs: NSAIDs, ampicillin, lithium
- Cancer: Hodgkin’s lymphoma, other lymphoproliferative diseases
- Toxins: mercury, lead, bee stings
- Infection: mononucleosis, HIV, immunizations
FSGS
- Unilateral renal agenesis
- Renal ablation – remnant kidney
- Sickle cell disease
- Morbid obesity
- Heroin nephropathy
- HIV nephropathy
- Pamidronate
- Vesicoureteral reflux
Membranous
- Immunologic disorders eg. SLE, RA, MCD
- Neoplasms e.g. Carcinoma (lung, colon, breast etc.), melanoma, leukemia, lymphoma
- Infections e.g. Hepatitis B, syphilis, malaria
- Medications e.g. Penicillamine, gold, captopril
