Most common cause of nephrotic range proteinuria in an adult is: (DNB Dec 10)
I. Systemic causes (25%)
a. Diabetes mellitus (most common cause), SLE, Amyloidosis
b. Drugs: Gold, penicillamine Q, probenecidQ, street heroin, captopril Q, NSAIDs Q
c. Infections: Bacterial endocarditis Q, hepatitis B Q, shunt infections, syphilis, malaria Q
d. Malignancy: Hodgkin’s and other lymphomas Q, leukemia, carcinoma of breast and GI tract Q
e. Allergic reactions
Extra Edge: DM is the most common cause of nephrotic syndrome in adult
II. Glomerular disease (75%)
a. Minimal change disease (90% in children and 15% in adults) b. Membranous (40% in adults)
c. Focal glomerulosclerosis d. Membranoproliferative GN
Clinical Features -
a. Patient usually presents with insidious onset of generalized edema, without a decrease in urine output.
b. Patient may complain of passing frothy urine due to presence of protein.
c. Nephrotic syndrome is associated with = ↑LDL, ↑Tg, ↓HDL
d. Patient of nephrotic syndrome can develop spontaneous peripheral arterial or venous thrombosis.
Specially Renal vein thrombosis due to
1. Increase Fibrinogen
2. Increase Lipoproteins
3. Reduced antithrombin III.
Extra Edge: Nephrotic syndrome due to diabetes mellitus, minimal change disease and focal segmental sclerosis are rarely associated with renal vein thrombosis