Urology Today.net

Site updated at Thursday, 12 May 2016

Common Urological Problems

Nephrotic Syndrome

  • - General Urology - Common Urological Problems - Medical Renal Disease
  • Jul 29, 2010
  • Comments
  • Viewed: 34718
Tags: | edema | focal glomerulosclerosis | hyperlipidemia | hypoalbuminemia |

Essentials of Diagnosis and General Considerations

  • Edema
  • Proteinuria >3.5 g/day
  • Hypoalbuminemia <3 g/dL
  • Hyperlipidemia: cholesterol >300 mg/100 mL
  • Lipiduria: free fat, oval fat bodies, fatty casts

Because treatment and prognosis vary with the cause of nephrotic syndrome,  renal biopsy is important.  Light microscopy,  electron microscopy,  and immunofluorescence identification of immune mechanisms diagnose most causes of nephrosis.

Glomerular diseases associated with nephrosis include the following:

Minimal Glomerular Lesions
Minimal-change nephropathy (nil disease)  accounts for about 20% of cases of nephrosis in adults and 90% in children. No abnormality is visible by examination of biopsy material with the light microscope.  With the electron microscope,  alterations of the GBM,  with effacement of foot processes of the epithelial cells, are evident. There is no evidence of immune disease by immunofluorescence studies. The response to treatment with corticosteroids is good,  but for patients who have frequent relapses with steroids or are steroid resistant, a course of cyclophosphamide or chlorambucil may induce a prolonged remission.

Patients who do not respond to these agents may show a favorable response with cyclosporine or tacrolimus. Renal function usually remains stable.

Diagnosis of Medical Renal Disease

Medical Renal Disease

Focal Glomerulosclerosis
Focal glomerulosclerosis is the second most common cause of nephrotic syndrome in children and an increasing cause of the nephrotic syndrome in adults.  The diagnosis is based on light microscope findings of segmental hyalinosis and sclerosis associated with effacement of the foot processes on electron microscopy. Focal glomerulosclerosis is frequently idiopathic but can be associated with human immunodeficiency virus infection and heroin use. A secondary form of focal glomerulosclerosis without the diffuse changes in foot processes may occur in patients with a solitary kidney,  hyperfiltration syndromes,  and reflux nephropathy.  There are reports of familial variants.  The response of the idiopathic form of focal glomerulosclerosis to therapy is suboptimal. Prolonged corticosteroid therapy produces remission in approximately 40%  of patients.

Over a 10-year period, approximately 50% of patients will have chronic renal failure. Idiopathic focal glomerulosclerosis has a recurrence rate of 25% after transplantation.

Membranous Nephropathy
Examination of biopsy material with the light microscope shows thickening of the glomerular cells but no cellular proliferation.  With the electron microscope,  irregular lumpy deposits appear between the basement membrane and the epithelial cells,  and new basement membrane material protrudes from the GBM as spikes or domes.

Immunofluorescence studies show diffuse granular deposits of Ig (especially IgG)  and complement (C3 component). As the membrane thickens, glomeruli become sclerosed and hyalinized.

The pathogenesis of most cases of membranous nephropathy in humans is unclear.  Several mechanisms have been suggested.  They include trapping of circulating immune complexes or binding of an antibody to scattered glomerular antigens (either present already or “planted” after a nonrenal-source antigen lodges in the glomerulus). 

There is considerable controversy regarding the effectiveness of therapy with steroids or immunosuppressive agents. Therapy should be most often used in patients at high risk of progressive renal failure with the following criteria:  proteinuria >5 g/day,  hypertension,  and elevated serum creatinine.

Page 1

1 2 Next »

Bookmark and Share

Post a comment [ + Comment here + ]

There are no comments for this entry yet. [ + Comment here + ]

Your details

* Required field

Please enter the word you see in the image below:

Comments are moderated by our editors, so there may be a delay between submission and publication of your comment. Offensive or abusive comments will not be published.

breast cancer3 - monosomy1 - renal tubular acidosis2 - chronic autoimmune disease1 - cystoscopy1 - triggering1 - bladder discomfort1 - pyelotomy1 - mesonephric duct1 - diagnostic test2 - martius flap1 - urinary frequency6 - neurogenic oab1 - puborectalis1 - microscopic hematuria1 - urea1 - vytorin1 - recurrent bladder infection1 - focused ultrasound surgery foundation1 - lupus nephritis3 - plco study1 - urethra3 - lab-made kidney1 - urine test3 - overactive1 - kidney problems2 - lower urinary tract symptom score1 - anorectal canal1 - low-calorie diet1 - pubocervical fascia1 -