Nephrotic Syndrome Essay

Acute onset of nephrotic syndrome: Nephrotic-range proteinuria can occur in more severe IgAN and is an adverse predictor of prognosis. However, some patients have an acute onset of nephrotic syndrome and renal biopsy reveals only mild mesangial proliferation, with the most prominent finding being diffuse fusion of the foot processes on electron microscopy, similar to that seen in minimal change. Furthermore, acute onset of nephrotic syndrome can be caused due to treatment with glucocorticoid ,a common treatment of IgAN, during remission. It is evident by these facts that acute onset of nephrotic syndrome is a poor indicator of IgAN compared to prolonged proteinuria even though the former might be more severe.

Hematuria without proteinuria:
In addition, isolated persistent hematuria at presentation may be associated with progressive disease over time(12,18) . The following observation is noticeable: In a study from China(12),,72 consecutive patients with IgAN who underwent renal biopsy because of hematuria with no or minimal proteinuria were followed for a median of seven years. Protein excretion above 1 g/day, hypertension, and GFR decline appeared in 33%, 26%, and 7% respectively.
Acute kidney injury with gross hematuria: Acute kidney injury (AKI) can occur during episodes of gross hematuria in patients with IgAN(23,24) .Renal biopsy in these patients reveals mesangial proliferation and segmental crescents in a small proportion of glomeruli . These findings are insufficient to account for the AKI, which has been ascribed to tubular obstruction by red cell casts. However, the most common histologic lesion is acute tubular necrosis, which may be induced by the iron released from lysed red cells in the