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Intrinsic renal disease (nephrotic syndrome (secondary causes (Hep B/C…

- - - - increased catabolism in proximal tubule
    - - structural damage to glomerular barrier
    - - increased salt and water retention
      - increased capillary hyrdaulic conductivity (TNFalpha and ANP)
  - - - commonest cause in children
      - effacement of podocyte foot processes
      - 70% of adults achieve remission with steroids but most relapse
      - idiopathic/NSAIDs/paraneoplastic
    - - 20-30% in adults
      - idiopathic/malignancy/Hep B/drugs/autoimmunity
      - diffusely thickened GBM
      - spontaneous remission in 30%
      - antibodies against phospholipase A2 present in 80%
    - - may be idiopathic or secondary
      - HIV associated with collapsing subtype
      - 50% have impaired renal function at diagnosis
      - spontaneous remission <10%
      - may respond to plasma exchange
    - - immune complex mediated
        
        underlying cause in most cases
      - complement mediated
        
        less common
        
        extrarenal manifestations
        
        prognosis poor
      - mesangial and endocapillary proliferation
      - thickened capillary basement membrane
      - double contouring of capillary walls
  - - - usually membranous
      - Hep C can cause MCGN
    - - membranous