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Diabetic Nephropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Nephrotic syndrome is of different causes based on patient age. The most common primary causes include minimal change disease, focal segmental glomerulosclerosis, and membranous nephropathy. Minimal change disease causes a fast onset of edema and heavy proteinuria, and usually affects children, with renal function remaining normal in most cases. Secondary causes only make up fewer than 10% of childhood cases. However, secondary causes make up more than 50% of adult cases, and include diabetic nephropathy and preeclampsia. Amyloidosis causes 4% of all cases. HIV-associated nephropathy occurs in patients with AIDS, and is a form of focal segmental glomerulosclerosis.
Nephrology
Published in John D Firth, Professor Ian Gilmore, MRCP Part 1 Self-Assessment, 2017
John D Firth, Professor Ian Gilmore
The diagnosis is minimal change glomerulonephritis, also known as minimal change nephropathy, minimal change disease, lipoid nephrosis and idiopathic nephrotic syndrome. Standard initial therapy is with corticosteroids, typically prednisolone at a dose of about 1 mg/kg/day, which introduces remission in around 80% of patients. Supportive therapies are also given, diuretics to clear oedema will clearly be appropriate in this case, and some nephrologists would prescribe warfarin to reduce risk of thromboembolism and a statin to reduce hypercholesterolaemia, although many would elect to see whether or not the patient went into a rapid remission that would render these agents unnecessary. Ciclosporin is useful as a steroid-sparing agent in patients who frequently relapse but would not be used as initial treatment.
Practice Paper 1: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
Nephrotic syndrome, not to be confused with nephritic syndrome, is characterized by loss of large amounts of protein in the urine due to an excessively leaky glomerular basement membrane. The features of nephrotic syndrome include proteinuria; peripheral oedema; hypoalbuminaemia; hypertension; hyperlipidaemia; hypercoagulability; and an increased risk of infection, including spontaneous bacterial peritonitis. In children, the main cause of nephrotic syndrome is minimal-change glomerulonephritis (>90% of cases). Minimal-change disease is thought to be secondary to abnormal T-cell activity that causes a reduction in the synthesis of anion channels within the glomerular basement membrane, thereby making it more permeable. On renal biopsy, the histological appearance is normal. Electron microscopy of the sample may reveal fused and abnormal podocytes. The treatment of minimal-change disease involves steroid therapy, fluid restriction, a low-salt diet, penicillin prophylaxis, ACE inhibitors to reduce proteinuria and statin therapy for hyperlipidaemia. Immunosuppression is occasionally indicated in severe and refractory disease.
Significance of M2 macrophage in tubulointerstitial disease secondary to primary Sjogren's disease
Published in Renal Failure, 2018
Jun Li, Ya-Fen Yu, Chang-Hua Liu, Cui-Mei Wang
Formalin-fixed, paraffin-embedded renal tissues were obtained from patients with pSS (n = 10), drug-associated chronic interstitial nephritis (CIN, n = 8, the drugs includes proton pump inhibitor and Chinese herbs). Renal tissues samples of minimal change disease patients (MCD, n = 5), and those obtained from normal control kidneys (n = 3) were used as negative controls. Morning urine samples before renal biopsy were collected for the detection of urinary osmotic pressure, urinary NAG and urinary β2- microglobulin. All patients with pSS fulfilled the international classification criteria for Sjögren’s syndrome (2012 American College of Rheumatology classification criteria for Sjögren’s syndrome) [9]. Exclusion criteria were the presence of malignancy, acute inflammation and sepsis. All the patients agreed and signed the informed consent. This study was performed in accordance with the Declaration of Helsinki. This study obtained the permission of the Ethics Committee of the affiliated hospital of Jiangnan University and the Clinical Medical College of Yangzhou University.
Spectrum of renal disease in HIV-infected children: report of five cases
Published in Paediatrics and International Child Health, 2018
Karalanglin Tiewsoh, Ankur Kumar Jindal, Dhrubajyoti Sharma, Sunil Arora, Ranjana W. Minz, Parimal Agrawal, Ritambhra Nada, Deepti Suri
Laboratory investigations. Urine protein was 43 mg/m2/hr, renal function was normal and there was a high HIV viral load (Table 1). Kidney biopsy demonstrated minimal change disease. In view of clinical and virological failure, the cART regimen was changed to abacavir, lamivudine and lopinavir/ritonavir but she continued to have proteinuria. Five months later, she developed fever, cough and respiratory distress. Contrast-enhanced computed tomography (CECT) of the chest demonstrated enlarged mediastinal lymph nodes, and lymph node biopsy confirmed high-grade non-Hodgkin lymphoma (NHL). Her parents refused further therapy and she was lost to follow-up.
Minimal change nephrotic syndrome secondary to the tumour necrosis factor-α inhibitor golimumab: a case report
Published in Scandinavian Journal of Rheumatology, 2021
A Panagiotou, V Zavvos, C Iatrou
Rheumatoid arthritis (RA) is a common inflammatory joint disease, characterized by progressive destruction of the synovium with joint damage, pain, and non-articular manifestations leading to adverse outcomes. Tumour necrosis factor-α (TNF-α) is fundamental in RA pathogenesis and TNF-α inhibitors are widely accepted treatment options, with renal complications rarely reported (1). We present a case of nephrotic syndrome due to minimal change disease (MCD), in a 67-year-old female patient with a 16 year history of RA treated with golimumab, with spontaneous remission following drug discontinuation.