Diagnostics

Confirmation of nephrotic-range proteinuria

• Qualitative assessment by urine dipstick (commonly used for screening)
  • Usually shows ≥ 3+ proteins
  • Hematuria may indicate concomitant glomerulonephritis.
• Quantitative assessment of urine protein excretion
  • 24-hour urine protein (test of choice): > 3.5 g/24 hours
  • Spot urine protein/creatinine ratio: > 3.5 g/g

Immune deposition

Mnemonic

1. Membranous nephropathy: subepithelial & ‘spike and dome’
2. Membranoproliferative glomerulonephritis Type II: intramembranous & ‘tram track’
3. Membranoproliferative glomerulonephritis Type I: subendothelial & ‘tram track’

Warning

podocyte = visceral epithelial cell

Classifications

1. Focal segmental glomerulosclerosis

Complications

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Thrombotic complications

• Venous thromboembolism (e.g., deep vein thrombosis, pulmonary embolism)
• Renal vein thrombosis: thrombus formation in the renal veins or their branches
  • Cause: hypercoagulable state (e.g., malignancies, antiphospholipid syndrome, nephrotic syndrome)
  • Manifestations
    • Flank pain
    • Hematuria
    • ↑ LDH
    • Anuria/renal failure in bilateral thrombosis
    • Scrotal edema
  • Diagnostics
    • CT angiography or MR venography (preferred modality in patients with renal injury or failure)
    • Doppler ultrasonography if no other diagnostic modality is available
  • Treatment
    • Anticoagulation
    • Thrombolysis or thrombectomy in selected patients
  • Complications: rupture of renal capsule, pulmonary embolism, kidney injury