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Common Urological Problems

Nephrotic Syndrome

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

Membranoproliferative Glomerulonephritis-Type I and Type II
In type I MPGN, light microscopy shows thickening of glomerular capillaries, accompanied by mesangial proliferation and obliteration of glomeruli.  With the electron microscope,  subendothelial deposits and growth of mesangium into capillary walls are demonstrable. Immunofluorescence studies show the presence of the C3 component of complement and,  rarely,  the presence of Ig.  The most common cause of MPGN type I is chronic hepatitis C virus infection.

This condition is usually associated with high levels of IgG/IgM.  Cryoimmunoglobulins may be present with normal or slightly reduced levels of complement.  There is no known effective treatment.

Type II MPGN is characterized by dense deposits visible by electron microscopy and lack of findings by immunofluorescence studies.  Treatment is unsatisfactory, and there is a high rate of recurrence after kidney transplantation.

Miscellaneous Diseases
Many medical illnesses that are metabolic,  autoimmune, or infectious, as well as neoplastic diseases and reactions to drugs and other toxic substances can produce glomerular disease.  These include diabetic glomerulopathy,  systemic lupus erythematosus, ANCA-positive renal disease (including Wegener’s granulomatosis), amyloid disease, multiple myeloma,  lymphomas,  carcinomas,  syphilis,  reaction to toxins, reaction to drugs (eg, trimethadione), and exposure to heavy metals.

A rare glomerular illness has been recently described with nephrotic syndrome:  fibrillary and immunotactoid glomerular nephritis. The lesions of fibrillary glomerulonephritis are characterized by randomly oriented fibril deposits 10-30 nm in diameter located within the mesangium and capillary wall. Immunotactoid glomerulopathy is characterized by deposits of microtubular structures of 18-19 nm and has been associated with lymphoproliferative disorders.

In contrast to amyloid,  the deposits in both diseases are Congo red-negative. Treatment is generally unsatisfactory.

***
Flavio G. Vincenti, MD, & William J.C. Amend, Jr., MD

***
REFERENCES

  1. Adler S: Diabetic nephropathy: Linking histology, cell biology, and genetics. Kidney Int 2004;66:2095.
  2. Alric L et al: Influence of antiviral therapy in hepatitis C virus-associated cryoglobulinemic MPGN. Am J Kidney Dis 2004;43:617.
  3. Appel GB et al: Membranoproliferative glomerulonephritis Type II (dense deposit disease): An update. J Amer Soc Neph 2005;16: 1392.
  4. Barratt J, Feehally J: IgA nephropathy. J Amer Soc Neph 2005;16: 2088.
  5. Braden GL et al: Tubulointerstitial diseases. Am J Kidney Dis 2005; 46:560.
  6. Buhaescu I et al: Systemic vasculitis: Still a challenging disease. Am J Kidney Dis 2005;46:173.
  7. Chesney R: The changing face of childhood nephrotic syndrome. Kidney Int 2004;66:1294.
  8. Flanc RS et al: Treatment of diffuse proliferative lupus nephritis: A meta-analysis of randomized controlled trials. Am J Kidney Dis 2004;43:197.
  9. Couser WG (guest editor): Frontiers in nephrology: Membranous nephropathy. J Amer Soc Neph 2005;16:1184.
  10. Ginzler EM et al: Mycophenolate mofetil or intravenous cyclophosphamide for lupus nephritis. N Engl J Med 2005;353:2219.
  11. Grantham JJ: Advancement in the understanding of polycystic kidney disease: A system approach. Kidney Int 2003;64: 1154.
  12. Heering P et al: Cyclosporine A and chlorambucil in the treatment of idiopathic focal segmental glomerulosclerosis. Am J Kidney Dis 2004;43:10.
  13. Hruska KA: Treatment of chronic tubulointerstitial disease: A new concept. Kidney Int 2002;61:1911.
  14. Imaging the Kidney-Radiologic Imaging 2006. (Excerpts) Nephron Clin Pract 2006;103:c19.
  15. Izzedine H et al: Oculorenal manifestations in systemic autoimmune diseases. Am J Kidney Dis 2004;43:209.
  16. Javaid B, Quigg RJ: Treatment of glomerulonephritis: Will we ever have options other than steroids and cytotoxics? Kidney Int 2005;67:1692.
  17. Nair R, Walker PD: Is IgA nephropathy the commonest primary glomerulopathy among young adults in the USA? Kidney Int 2006;69:1455.
  18. Noris M, Remuzzi G: Hemolytic uremic syndrome. J Amer Soc Neph 2005;16:1035.
  19. Perna A et al: Immunosuppressive treatment for idiopathic membranous nephropathy: A systematic review. Am J Kidney Disease 2004;44:385.
  20. Rosner MH, Bolton WK: Renal function testing. Am J Kidney Dis 2006;47:174.
  21. Rossert J: Drug-induced acute interstitial nephritis. Kidney Int 2001; 60:804.
  22. Tenenhouse HS, Murer H: Disorders of renal tubular phosphate transport. J Am Soc Neph 2003;14:240.
  23. Troyanov S et al: Renal pathology in idiopathic membranous nephropathy: A new perspective. Kidney Int 2006;69:1641.
  24. Wilmer WA et al: Management of glomerular proteinuria: A commentary. J Amer Soc Neph 2003;14:3217.

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