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For further information, see CMDT Part 22-15: Nephrotic Spectrum Glomerular Diseases

Key Features

  • Proteinuria > 3 g/day

  • Albumin < 3 g/dL

  • Peripheral edema

  • Hyperlipidemia

  • Oval fat bodies may be seen in the urine

  • Most common cause is diabetes; other causes include

    • Minimal change disease

    • Focal glomerular glomerulosclerosis

    • Membranous nephropathy

    • Amyloidosis

Clinical Findings

  • Peripheral edema with serum albumin < 3 g/dL

  • Edema can become generalized

  • Dyspnea caused by pulmonary edema, pleural effusions, and diaphragmatic compromise with ascites

Diagnosis

  • Urinalysis: proteinuria; few cellular elements or casts

  • Oval fat bodies appear as "grape clusters" under light microscopy and "Maltese crosses" under polarized light

  • Serum albumin < 3 g/dL, serum protein < 6 g/dL

  • Hyperlipidemia

  • Elevated erythrocyte sedimentation rate

  • The following tests may help elucidate the underlying cause of glomerular disease

    • Complement levels

    • Serum and urine protein electrophoresis

    • Serum free light chains

    • Antinuclear antibodies

    • Phospholipase A2 receptor (PLA2R) antibody titers

    • HbA1c

    • Serologic testing for hepatitis B and C, HIV, and syphilis

  • Kidney biopsy indicated in adults with new-onset idiopathic nephrotic syndrome if a primary renal disease is suspected

Treatment

  • In those with sub-nephrotic proteinuria, dietary protein restriction may be helpful in slowing progression of kidney disease

  • Salt restriction for edema

  • Loop and thiazide diuretics in combination

  • Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers

  • Antilipidemic agents

  • In patients with thrombosis, warfarin for at least 3–6 mo

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