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Differential Diagnosis of Nephrotic Syndrome

Provided by Expert Zhang Youkang on 2012-10-24 15:38

Nephrotic Syndrome (NS) refers to a group of symptoms such as proteinuria, edema, high blood fat and hypoproteinemia. Depending on varied causes, it can be divided into primary and secondary NS. Though these two categories share similar clinical manifestations, we need to make a differential diagnosis of NS because the pathogenesis and treatment vary in large degree.

▪ Primary Nephrotic Syndrome

Minimal Change Disease is mainly found in children and adolescents with concealed nature. Typically, patients present gross hematuria.

Membranous Nephropathy. The onset of this disease is usually after the age of 35. It often develops slowly with latent feature. Patients are more likely to have thrombosis of renal vein and rarely gross hematuria.

Proliferative Membranous Nephropathy often occurs before the age of 30 with a sudden onset. Almost all patients have microscopic hematuria and about 1/3 of them suffer from elevated blood pressure.

Mesangial Proliferative Glomerulonephritis mainly occurs in young people with acute onset. Patients may have hematuria (mainly microscopic hematuria) and mild or moderate high blood pressure.

FSGS mainly attacks young people always with a hidden onset. Patients usually present microscopic hematuria and renal damages.

▪ Secondary to Nephrotic Syndrome

1. Henoch-Schonlein Purpura Nephritis is prone to adolescents, which takes skin purpura as the typical symptom. Patients may be also accompanied with pain of the joints and abdomine and melena. Hematuria and/or proteinuria often appear after 1~4 weeks of the rashes. The rashes contribute to the differential diagnosis.

2. Lupus nephritis is common in young females, which is characterized by more pipe damage, such as joint pain, fever, erythema, face butterfly, liver and cardiovascular system disease, etc. Lupus erythematosus can be found in the blood cells, and plasma globulin increased significantly.

3. Diabetic kidney disease occurs in patients with long-standing diabetes (more than 5 years). In the early stage, there is increased excretion of MAlb, which will develop into massive protienuria and NS over time. The medical history of diabetes and retonipathy can help us make a differential diagnosis.

4. Renal Amyloidosis seems to mainly occur in middle-aged above people with chronic inflammation and chronic suppurative foci of disease.

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