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What is the most common cause of nephrotic syndrome in US adults

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What is the most common cause of nephrotic syndrome in US adults

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    2. What is the most common cause of nephrotic syndrome in US adults? Minimal Change Disease Focal and Segmental Glomerulosclerosis IgA Nephropathy DM Membranous Nephropathy

    3. In glomerulonephritis, most urine cell casts originate from the glomerulus True False These choices are overwhelming me

    4. Goals for Today Provide a conceptual framework to segregate glomerular diseases What we will NOT DO: go into detail for every glomerular disease, Dr Popli will do this later! We will NOT discuss RPGN Do some questions

    5. Glomerular apparatus Endothelium Basement membrane Podocytes

    6. Glomerular Disease Nephritic (a.k.a. acute glomerulonephritis) Focal Diffuse May burn out to Nephrotic Also a disease in and of itself

    7. Etiologies of Acute GN Ag-Ab complex deposition Antibodies against the BM Direct injury Idiopathic Inherited All result in active inflammation in the glomerulus, and active sediment coming out in the urine

    8. Nephritic Syndrome HTN Proteinuria (trace to nephrotic range) Active sediment (Often dysmorphic) RBCs +/- casts WBCs +/- casts Varying complement levels FENa almost always <1%

    9. The hallmark of nephritic syndromes is an active urine sediment

    10. Nephritic Syndromes with Low Complement Renal Post-infectious Strep Hep B Membranoproliferative GN Systemic SLE Endocarditis cryoglobulinemia

    11. Nephritic with Normal Complement Renal IgA Alports ANCA+ RPGN Systemic Goodpastures Vasculitides TTP/HUS

    13. Complement levels help discriminate the etiology of nephrotic syndrome True False I like complements!

    14. Nephrotic Syndrome >3g proteinuria/day Albumin Igs TBG Antithrombin III Bland sediment (except fat) Hypoalbuminemia (serum <3g/dL) Hyperlipidemia Fat droplets in urine (Maltese Crosses) Ascites, effusionsbut not pulm edema NORMAL complement (except active SLE)

    15. Nephrotic Syndrome Renal Minimal Change Membranous FSGS Systemic DM MM/Amyloidosis SLE

    22. Typically idiopathic, FSGS is similar to MCD in that there is diffuse loss of foot processes. As per its name, only has focal sclerosis in segments of the kidney especially around the juxta-medullary glomeruli. Most common cause of idiopathic nephrotic syndrome in African Americans Associated diseases HIV Obesity Sickle cell anemia Heme malignancies Chronic vesicoureteral reflux FSGS

    25. Membranous Nephropathy Usually idiopathic; most common cause of idiopathic nephrotic syndrome in adults Some known causes/associations Chronic infection: malaria, HBV, HCV, syphilis Drugs: gold, penicillamine, NSAIDs Autoimmune disease May be manifestation of solid tumor malignancy Pursue age-appropriate cancer screening ALL glomeruli affected on biopsy: diffuse thickening of BM with immune complex spikes

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