Nephrotic syndrome causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mehrian Jafarizade, M.D [2], Yazan Daaboul, Serge Korjian

Overview

Nephrotic syndrome can occur primarily or due to systemic diseases. The most common cause of nephrotic syndrome in children is minimal change disease. The most common primary causes in adults are focal segmental glomerulosclerosis (FSGS), minimal change disease, and membranous nephropathy. Approximately 30 percent of adults have secondary nephrotic syndrome due to diabetes mellitus, SLE, or amyloidosis. The most common cause of secondary nephrotic syndrome in adults is diabetes mellitus.

Causes

Nephrotic syndrome can occur primarily or due to systemic diseases. The most common cause of nephrotic syndrome in children is minimal change disease. The most common primary causes in adults are focal segmental glomerulosclerosis (FSGS), minimal change disease, and membranous nephropathy. Approximately 30 percent of adults have secondary nephrotic syndrome due to diabetes mellitus, SLE, or amyloidosis.^[1]^[2]^[3]^[4]^[5]^[6]^[7]

Primary Causes

Primary renal disorders, such as primary glomerulonephritides, may cause primary nephrotic syndrome. Differentiation between different types of glomerular diseases is often made by clinical suspicion and by renal biopsy, which includes light microscopy, immunofluorescence, and ideally electron microscopy.

Secondary Causes

Secondary causes of renal disorders cause secondary nephrotic syndrome. The most common cause of secondary nephrotic syndrome in adults is diabetes mellitus. Shown below is a table of the causes of nephrotic syndrome by age group.^[8]

Common Causes of Nephrotic Syndrome by Age

Age (Years)	Cause of Nephrotic Syndrome
< 15	Congenital nephrotic syndrome Minimal change disease Focal segmental glomerulosclerosis Membranous nephropathy
15-40	Focal segmental glomerulosclerosis Lupus nephritis Minimal change disease Membranous nephropathy Diabetic nephropathy Pre-eclampsia Late post-infectious glomerulonephritis IgA nephropathy
>40	Focal segmental glomerulosclerosis Membranous nephropathy Diabetic nephropathy Minimal change disease IgA nephropathy Primary amyloidosis Light chain deposition disease Benign nephrosclerosis Late post-infectious glomerulonephritis

^{Adapted from Rose BD. Pathophysiology of renal diseases, ed. 2. New York, McGraw-Hill, 1987,p. 167}

Drug Induced

Causes by Organ System

Cardiovascular	Endocarditis
Chemical/Poisoning	Gold, mercury
Dental	No underlying causes
Dermatologic	Dermatomyositis,
Drug Side Effect	Agalsidase beta, Certolizumab pegol, Coagulation factor IX, Olsalazine, Sodium aurothiomalate, Trimethadione, Ziv-aflibercept , Interferon, lithium, NSAID, Penicillamine, Probenecid, Sorafenib
Ear Nose Throat	No underlying causes
Endocrine	Diabetes mellitus, thyroid disease
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	Castleman's disease, sickle cell anemia
Iatrogenic	No underlying causes
Infectious Disease	HIV, Infectious mononucleosis, malaria, streptococcal infection, syphilis, toxoplasmosis, viral hepatitis
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	Preeclampsia
Oncologic	Leukemia, lymphoma, multiple myeloma
Ophthalmologic	No underlying causes
Overdose/Toxicity	Heroin
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	Amyloidosis, chronic interstitial nephritis, fabry's disease, Goodpasture's syndrome, oligomeganephronia, orthostatic proteinuria, renal vein thrombosis
Rheumatology/Immunology/Allergy	Bee sting, food allergens, Graft vs. host disease, Henoch-Schonlein purpura, Kimura's disease, mixed connective tissue disease, polyarteritis nodosa, rheumatoid arthritis, sarcoidosis, Sjogren's syndrome, systemic lupus erythematosus, vasculitis
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Lipoatrophy, obesity

Causes of Secondary Causes in Alphabetical Order

References

↑ Rivera F, López-Gómez JM, Pérez-García R (September 2004). "Clinicopathologic correlations of renal pathology in Spain". Kidney Int. 66 (3): 898–904. doi:10.1111/j.1523-1755.2004.00833.x. PMID 15327378.
↑ Haas M, Meehan SM, Karrison TG, Spargo BH (November 1997). "Changing etiologies of unexplained adult nephrotic syndrome: a comparison of renal biopsy findings from 1976-1979 and 1995-1997". Am. J. Kidney Dis. 30 (5): 621–31. PMID 9370176.
↑ Simon P, Ramee MP, Boulahrouz R, Stanescu C, Charasse C, Ang KS, Leonetti F, Cam G, Laruelle E, Autuly V, Rioux N (September 2004). "Epidemiologic data of primary glomerular diseases in western France". Kidney Int. 66 (3): 905–8. doi:10.1111/j.1523-1755.2004.00834.x. PMID 15327379.
↑ Braden GL, Mulhern JG, O'Shea MH, Nash SV, Ucci AA, Germain MJ (May 2000). "Changing incidence of glomerular diseases in adults". Am. J. Kidney Dis. 35 (5): 878–83. PMID 10793022.
↑ Malafronte P, Mastroianni-Kirsztajn G, Betônico GN, Romão JE, Alves MA, Carvalho MF, Viera Neto OM, Cadaval RA, Bérgamo RR, Woronik V, Sens YA, Marrocos MS, Barros RT (November 2006). "Paulista Registry of glomerulonephritis: 5-year data report". Nephrol. Dial. Transplant. 21 (11): 3098–105. doi:10.1093/ndt/gfl237. PMID 16968733.
↑ Bahiense-Oliveira M, Saldanha LB, Mota EL, Penna DO, Barros RT, Romão-Junior JE (February 2004). "Primary glomerular diseases in Brazil (1979-1999): is the frequency of focal and segmental glomerulosclerosis increasing?". Clin. Nephrol. 61 (2): 90–7. PMID 14989627.
↑ Gesualdo L, Di Palma AM, Morrone LF, Strippoli GF, Schena FP (September 2004). "The Italian experience of the national registry of renal biopsies". Kidney Int. 66 (3): 890–4. doi:10.1111/j.1523-1755.2004.00831.x. PMID 15327376.
↑ Eddy AA, Symons JM (2003). "Nephrotic syndrome in childhood". Lancet. 362 (9384): 629–39. doi:10.1016/S0140-6736(03)14184-0. PMID 12944064.

[pmid15327378-1] Rivera F, López-Gómez JM, Pérez-García R (September 2004). "Clinicopathologic correlations of renal pathology in Spain". Kidney Int. 66 (3): 898–904. doi:10.1111/j.1523-1755.2004.00833.x. PMID 15327378.

[pmid9370176-2] Haas M, Meehan SM, Karrison TG, Spargo BH (November 1997). "Changing etiologies of unexplained adult nephrotic syndrome: a comparison of renal biopsy findings from 1976-1979 and 1995-1997". Am. J. Kidney Dis. 30 (5): 621–31. PMID 9370176.

[pmid15327379-3] Simon P, Ramee MP, Boulahrouz R, Stanescu C, Charasse C, Ang KS, Leonetti F, Cam G, Laruelle E, Autuly V, Rioux N (September 2004). "Epidemiologic data of primary glomerular diseases in western France". Kidney Int. 66 (3): 905–8. doi:10.1111/j.1523-1755.2004.00834.x. PMID 15327379.

[pmid10793022-4] Braden GL, Mulhern JG, O'Shea MH, Nash SV, Ucci AA, Germain MJ (May 2000). "Changing incidence of glomerular diseases in adults". Am. J. Kidney Dis. 35 (5): 878–83. PMID 10793022.

[pmid16968733-5] Malafronte P, Mastroianni-Kirsztajn G, Betônico GN, Romão JE, Alves MA, Carvalho MF, Viera Neto OM, Cadaval RA, Bérgamo RR, Woronik V, Sens YA, Marrocos MS, Barros RT (November 2006). "Paulista Registry of glomerulonephritis: 5-year data report". Nephrol. Dial. Transplant. 21 (11): 3098–105. doi:10.1093/ndt/gfl237. PMID 16968733.

[pmid14989627-6] Bahiense-Oliveira M, Saldanha LB, Mota EL, Penna DO, Barros RT, Romão-Junior JE (February 2004). "Primary glomerular diseases in Brazil (1979-1999): is the frequency of focal and segmental glomerulosclerosis increasing?". Clin. Nephrol. 61 (2): 90–7. PMID 14989627.

[pmid15327376-7] Gesualdo L, Di Palma AM, Morrone LF, Strippoli GF, Schena FP (September 2004). "The Italian experience of the national registry of renal biopsies". Kidney Int. 66 (3): 890–4. doi:10.1111/j.1523-1755.2004.00831.x. PMID 15327376.

[pmid12944064-8] Eddy AA, Symons JM (2003). "Nephrotic syndrome in childhood". Lancet. 362 (9384): 629–39. doi:10.1016/S0140-6736(03)14184-0. PMID 12944064.

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