CAUSES
1. Primary renal disease:
. Fibrillary glomerulopathy (primary)
. Focal glomerulonephritis
. Focal glomerulosclerosis (FGS)
. IgA nephropathy
. Membranoproliferative glomerulonephritis (MPGN)
. Membranous glomerulonephritis (MGN)
. Mesangial proliferative glomerulonephritis
. Minimal change disease (MCD)
. Rapidly progressive glomerulonephritis (RPGN)
. Congenital nephrotic syndrome
2. Secondary renal disease: Associated primary renal disease shown in brackets:
. Allergens (snake venoms, antitoxins, poison ivy, insect stings)
. Amyloidosis
. Carcinoma (bronchogenic, breast, colon, stomach, kidney) [MGN, etc]
. Diabetes mellitus (most common)
. Erythema multiforme
. Fibrillary glomerulopathy (secondary: amyloid,
cryoglobulins, multiple myeloma, chronic lymphocytic leukemia [CLL]
. Henoch-Schonlein purpura
. Heredofamilial (Alports syndrome, Fabry disease)
. Infections: ventriculoatrial shunt infection, bacterial endocarditis, HIV, HBV, HCV, schistosomiasis, TB, leprosy, post-strep GN (20% are nephrotic)
. Leukemias
. Lymphoma (Hodgkin [MCD], non-Hodgkin [MGN])
. Focal glomerulosclerosis (refl ux nephropathy, heroin abuse, nephron ablation, extensive glomerular scarring in acute glomerulonephritis, chronic renal allograft rejection, end stage kidney, morbid obesity, thromboembolism)
. Malignant hypertension
. Melanoma
. Nephrotoxins and drugs (gold, penicillamine, mercury [MGN], NSAIDs [MCD] and interstitial nephritis
. Polyarteritis nodosa
. Preeclampsia
. Sarcoid
. Serum sickness
. Sjogren syndrome
. Systemic lupus erythematosus (SLE) [MGN, FGS, focal, mesangial, diffuse, proliferative]
. Toxemia of pregnancy
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DIFFERENTIAL DIAGNOSIS See Causes.
Is the disease predominantly nephrotic (protein without hematuria) such as MCD or MGN; or predominantly nephritic (protein plus blood) such as MPGN or FGS?
LABORATORY
. Hypoalbuminemia
. Hyperlipidemia
. Azotemia
. Hypercholesterolemia
. Urine
. Proteinuria (> 3 gm/24 hr)
. Glycosuria
. Hematuria
. Aminoaciduria
. Granular casts
. Hyaline casts
. Fatty casts
. Foamy appearance
. Lipiduria
SPECIAL TESTS:
*RENAL BIOPSY
SERLOGICAL MARKERS -
* C-3 LEVELS DECREASED IN IMMUNE COMPLEX GLOMERULONEPHRITIS
* ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES- INCREASED IN PAUCI- IMMUNE GLOMERULONEPHRITIS
* ANTIGLOMERULAR BASEMENT MEMBRANE ANTIBODIES - INCREASED IN ANTI GLOMERULAR BASEMENT MEMBRANE DISEASE
* POST STREPTOCOCCAL GLOMERULONEPHRITIS - ASLO TITRE, ANTI DNASE B, ANTI NADASE ANTIBODIES, ANTIHYALURONIDASE ANTIBODIES, ANTISTREPTOKINASE ANTIBODIES.
β’ Complement levels
β’ Antinuclear antibody, anti-dsDNA
β’ Serum protein electrophoresis (SPEP)
β’ Urine immune electrophoresis
β’ Blood cultures
β’ Diabetic testing
β’ HBV, HCV, HIV, RPR
β’ Fat pad biopsy
IMAGING
β’ X-ray
β’ Ultrasound
β’ CT
β’ MRI or venography for renal vein thrombosis
β’ Fluorescein angiography (for retinopathy)