Most common nephrotic syndrome in elderly patients
Ans. b (Membranous GN) (Ref H-17th/1791)# MEMBRANOUS GN accounts for approx 30% of cases of nephrotic syndrome in adults with peak incidence between 30-50 yrs age.# It is rare in childhood and by far the most common cause of nephrotic syndrome in the elderly# In 25-30% of cases, MGN is secondary to malignancy (solid tumors of the breast, lung, colon), infection (hepatitis B, malaria, schistosomiasis), or rheumatologic disorders like lupus or rarely rheumatoid arthritis.# Male to female ratio of 2:1.MEMBRANOUS GLOMERULONEPHRITISA. Primary/idiopathic membranous glomerulonephritisB. Secondary membranous glomerulonephritis1. Infection: Hepatitis B and C, syphilis, malaria, schistosomiasis, leprosy, filariasis2. Cancer: Breast, colon, lung, stomach, kidney, esophagus, neuroblastoma3. Drugs: gold, mercury, penicillamine, nonsteroidal anti-inflammatory agents, probenecid4. Autoimmune diseases: systemic lupus erythematosus, rheumatoid arthritis, primary biliary cirrhosis, dermatitis herpetiformis, bullous pemphigoid, myasthenia gravis, Sjogren's syndrome, Hashimoto's thyroiditis5. Other systemic diseases: Fanconi's syndrome, sickle cell anemia, diabetes, Crohn's disease, sarcoidosis, Guillain- Barre syndrome, Weber-Christian disease, angiofollicular lymph node hyperplasia# Uniform thickening of the BM along the peripheral capillary loops is seen by light microscopy on renal biopsy.# Immunofluorescence demonstrates diffuse granular deposits of IgG and C3, and electron microscopy typically reveals electron-dense subepithelial deposits.# Eighty percent of patients with MGN present with nephrotic syndrome and nonselective proteinuria. Microscopic hematuria is seen in up to 50% of patients. Spontaneous remissions occur in 20-33% of patients and often occur late in the course after years of nephrotic syndrome. One-third of patients continue to have relapsing nephrotic syndrome.# Although thrombotic complications are a feature of all nephrotic syndromes, MGN has the highest reported incidences of renal vein thrombosis, pulmonary embolism, and deep vein thrombosis.# Rx: In addition to the Rx of edema, dyslipidemia, and hypertension, inhibition of the renin-angiotensin system is recommended.Recommendations based on small clinical studies are to treat with steroids and cyclophosphamide, chlorambucil, or cyclosporine.Additional Educational Points# The renal lesions most commonly seen, in order of decreasing frequency, are cryoglobulinemic glomerulonephritis, MGN, and Type I MPGN.# All cases with borderline lepromatous and lepromatous types of leprosy have various forms of glomerulonephritis. Most common is focal glomerulonephritis followed by mesangioproliferative glomerulonephritis or renal amyloidosis.
Minimal change GN
Membranous GN
IgA nephropathy
None of the above
Kidney