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Approach to the Patient with Nephrotic Syndrome

  • Leslie F. Thomas
  • Harini A. Chakkera
Chapter

Abstract

A 50-year-old woman with no significant past medical history acutely develops bilateral lower extremity pitting edema. A thorough evaluation of cardiac and hepatic functions is unremarkable; however, urinalysis reveals significant proteinuria. Further testing shows an elevated serum creatinine level of 1.8 mg/dL, low serum albumin level of 2.2 g/dL, and hyperlipidemia (total cholesterol 385 mg/dL, triglycerides 480 mg/dL, LDL 245 mg/dL, and HDL 44 mg/dL). Urinary protein measures 5.2 g in a 24-h collection. The clinical diagnosis of nephrotic syndrome is made.

Keywords

Nephrotic Syndrome Membranous Nephropathy Minimal Change Disease Glomerular Filtration Barrier Elevated Serum Creatinine Level 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Orth SR, Ritz E. The nephrotic syndrome. N Engl J Med. 1998;338(17):1202–11.PubMedCrossRefGoogle Scholar
  2. 2.
    Hull RP, Goldsmith DJ. Nephrotic syndrome in adults. BMJ. 2008;336(7654):1185–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Bernard DB. Extrarenal complications of the nephrotic syndrome. Kidney Int. 1988;33(6):1184–202.PubMedCrossRefGoogle Scholar
  4. 4.
    Somlo S, Mundel P. Getting a foothold in nephrotic syndrome. Nat Genet. 2000;24(4):333–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Korbet SM, Genchi RM, Borok RZ, Schwartz MM. The racial prevalence of glomerular lesions in nephrotic adults. Am J Kidney Dis. 1996;27(5):647–51.PubMedCrossRefGoogle Scholar
  6. 6.
    Haas M, Meehan SM, Karrison TG, Spargo BH. Changing etiologies of unexplained adult nephrotic syndrome: a comparison of renal biopsy findings from 1976–1979 and 1995–1997. Am J Kidney Dis. 1997;30(5):621–31.PubMedCrossRefGoogle Scholar
  7. 7.
    Swaminathan S, Leung N, Lager DJ, et al. Changing incidence of glomerular disease in Olmsted County, Minnesota: a 30-year renal biopsy study. Clin J Am Soc Nephrol. 2006;1(3):483–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Kopp JB, Smith MW, Nelson GW, et al. MYH9 is a major-effect risk gene for focal segmental glomerulosclerosis. Nat Genet. 2008;40(10):1175–84.PubMedCrossRefGoogle Scholar
  9. 9.
    D’Agati V. Pathologic classification of focal seg­mental glomerulosclerosis. Semin Nephrol. 2003;23(2):117–34.PubMedCrossRefGoogle Scholar
  10. 10.
    Thomas DB, Franceschini N, Hogan SL, et al. Clinical and pathologic characteristics of focal segmental glomerulosclerosis pathologic variants. Kidney Int. 2006;69(5):920–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Beck Jr LH, Bonegio RG, Lambeau G, et al. M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy. N Engl J Med. 2009;361(1):11–21.PubMedCrossRefGoogle Scholar
  12. 12.
    Padiyar A, Bodziak KA, Hricik DE, Augustine JJ. Clinical predictors of proteinuria after conversion to sirolimus in kidney transplant recipients. Am J Transplant. 2010;10(2):310–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Sirolimus and proteinuria in renal transplant patients: evidence for a dose-dependent effect on slit ­diaphragm-associated proteins. Stallone G, Infante B, Pontrelli P, Gigante M, Montemurno E, Loverre A, Rossini M, Schena FP, Grandaliano G, Gesualdo L.Transplantation. 2011 May 15;91(9):997–1004.Google Scholar
  14. 14.
    Loriga G, Ciccarese M, Pala PG, et al. De novo everolimus-based therapy in renal transplant recipients: effect on proteinuria and renal prognosis. Transplant Proc. 2010;42(4):1297–302.PubMedCrossRefGoogle Scholar
  15. 15.
    Hariharan S, Adams MB, Brennan DC, et al. Recurrent and de novo glomerular disease after renal transplantation: a report from Renal Allograft Disease Registry (RADR). Transplantation. 1999;68(5):635–41.PubMedCrossRefGoogle Scholar
  16. 16.
    Vinai M, Waber P, Seikaly MG. Recurrence of focal segmental glomerulosclerosis in renal allograft: an in-depth review. Pediatr Transplant. 2010;14(3):314–25.PubMedCrossRefGoogle Scholar
  17. 17.
    Ballmer PE, Weber BK, Roy-Chaudhury P, et al. Elevation of albumin synthesis rates in nephrotic patients measured with [1–13C]leucine. Kidney Int. 1992;41(1):132–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Praga M, Borstein B, Andres A, et al. Nephrotic proteinuria without hypoalbuminemia: clinical characteristics and response to angiotensin-converting enzyme inhibition. Am J Kidney Dis. 1991;17(3):330–8.PubMedGoogle Scholar
  19. 19.
    Praga M, Hernandez E, Morales E, et al. Clinical features and long-term outcome of obesity-associated focal segmental glomerulosclerosis. Nephrol Dial Transplant. 2001;16(9):1790–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Marsh JB. Lipoprotein metabolism in the nephrotic syndrome. Front Biosci. 2002;7:e326–38.PubMedCrossRefGoogle Scholar
  21. 21.
    Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function—measured and estimated glomerular filtration rate. N Engl J Med. 2006;354(23):2473–83.PubMedCrossRefGoogle Scholar
  22. 22.
    Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.PubMedGoogle Scholar
  23. 23.
    Bomback AS, Kshirsagar AV, Amamoo MA, Klemmer PJ. Change in proteinuria after adding aldosterone blockers to ACE inhibitors or angiotensin receptor blockers in CKD: a systematic review. Am J Kidney Dis. 2008;51(2):199–211.PubMedCrossRefGoogle Scholar
  24. 24.
    Mann JF, Schmieder RE, McQueen M, et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet. 2008;372(9638):547–53.PubMedCrossRefGoogle Scholar
  25. 25.
    Dharmaraj R, Hari P, Bagga A. Randomized cross-over trial comparing albumin and frusemide infusions in nephrotic syndrome. Pediatr Nephrol. 2009;24(4):775–82.PubMedCrossRefGoogle Scholar
  26. 26.
    Vaziri ND, Liang K. Effects of HMG-CoA reductase inhibition on hepatic expression of key cholesterol-regulatory enzymes and receptors in nephrotic syndrome. Am J Nephrol. 2004;24(6):606–13.PubMedCrossRefGoogle Scholar
  27. 27.
    Olbricht CJ, Wanner C, Thiery J, Basten A. Simvastatin in nephrotic syndrome. Simvastatin in Nephrotic Syndrome Study Group. Kidney Int Suppl. 1999;71:S113–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Appel GB, Waldman M, Radhakrishnan J. New approaches to the treatment of glomerular diseases. Kidney Int. 2006;70(S104):S45–50.CrossRefGoogle Scholar
  29. 29.
    Polanco N, Gutierrez E, Covarsi A, et al. Spontaneous remission of nephrotic syndrome in idiopathic membranous nephropathy. J Am Soc Nephrol. 2010;21(4):697–704.PubMedCrossRefGoogle Scholar
  30. 30.
    Fervenza FC, Sethi S, Specks U. Idiopathic membranous nephropathy: diagnosis and treatment. Clin J Am Soc Nephrol. 2008;3(3):905–19.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Nephrology and HypertensionMayo Clinic ArizonaPhoenixUSA

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