Ashfaq A, Verace MA, Susin M, Bellucci AG
Clinical spectrum of presumed idiopathic nephrotic syndrome (NS)
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1327 1996
The records of one hundred thirty seven patients who underwent renal
biopsy for presumed idiopathic nephrotic syndrome between 1970 and 1993
were reviewed. Follow-up was at least 2 years; ages ranged from 15-92, 70%
of patients were male. Twenty nine patients (21%) were found to have a
secondary cause of NS. Seven patients had a lymphoproliferative
malignancy, 6 had a solid tumor, 3 had unsuspected diabetic
glomerulosclerosis and 13 had primary renal amyloidosis. Ninety six
percent of 72 patients under age 50 had a primary renal disease, whereas 25
of 65 (38%) of patients over 50 had an underlying cause for NS. Thirty two
percent of patients with membranous histology over age 50 had an underlying
malignancy. The authors conclude that older patients have a high incidence
of secondary NS, particularly amyloidosis.
Comment: The high incidence of amyloidosis in this study (almost
10%) is
suprising and I do not believe generalizable. Whether patients were
adequately evaluated prior to biopsy (including chest x-ray, careful
physical exam for lymph nodes and spleen, stool occult blood, SPEP and
UPEP) is not noted; more thorough pre-biopsy workup may have picked up some
of these "unanticipated" secondary glomerulopathies. The point that
patients over age 50 may have a secondary cause for NS is well taken.
(Stephen Pastan, M.D., Emory Clinic, Atlanta, GA)
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Am Soc Nephrol
Nephrotic Syndrome :
Pathogenesis, complications, RVT
Proteinuria/Hematuria :
Diagnostic approach to proteinuria