Figure 1.
Figure 2.
Figure 3.
Classical features of nephritic and nephrotic syndrome
| Nephritic syndrome | Nephrotic syndrome |
|---|---|
| Salt-water retention edema (increased hydrostatic pressure) | Loose part edema (decreased oncotic pressure edema) |
| • Starts in the dependent part (legs, ankles) Edema in other parts at a later stage | • Starts with loose tissue (upper eyelids, genitalia) Edema in dependent parts at a later stage |
| New onset or accelerated hypertension | Pleural effusion, ascites, hyperlipidemia, hypoalbuminemia |
| Dysmorphic RBC in UA | Usually, no RBC in UA, not dysmorphic if presented |
| RBC cast | Oval fat body (degenerating tubular epithelial cells filled that contain refractile fat droplets) |
| Nephrotic or sub-nephrotic range proteinuria | Nephrotic range proteinuria |
| Usually with elevated Cr/decreased eGFR | Meet all the criteria of nephrotic syndrome |
| 1. Generalized edema | |
| 2. Nephrotic range proteinuria (≥3.5 g/d) | |
| 3. Hypoalbuminemia (<3.0-3.5 g/dL, depends on assay) |
Complement levels in GN with classical and alternative pathway
| Pathway | Disease | C3 | C4 |
|---|---|---|---|
| Classical | LN | ↓ | ↓↓ |
| pathway | Mixed cryoglobulinemic GN | ↓ or ↔ | ↓↓ |
| Alternative | C3 GN | ↓ or ↔ | ↔ |
| pathway | Infection-related GN | ↓ | ↓ or ↔ |
| Atypical hemolytic-uremic syndrome | ↓ | ↔ | |
| Atheroembolic disease | ↓ or ↔ | ↓ or ↔ | |
| Other non-GN conditions that cause hypocomplementemia | |||
| • Severe sepsis | |||
| • Malnutrition | |||
| • Hepatic failure |
Prevalence of kidney biopsy pathological diagnosis (top 10 most common) [28–30]
| USA/Canada (n = 23,391) Survey 2012–2013 | Europe (n = 15,042) Survey 2012–2013 | Latin America (n = 2,561) Survey 2012–2013 | Japan (n = 28,728) 2007–2017 | Thailand (n = 5,893) 2000–2014 |
|---|---|---|---|---|
| FSGS (19%) | IgAN/HSP (22%) | LN (38%) | IgAN/HSP (33%) | LN (32%) |
| DN (19%) | FSGS (15%) | FSGS (16%) | MN (9%) | IgAN/HSP (21%) |
| IgAN/HSP (12%) | MN (13%) | MN (11%) | FSGS/NS (9%) | MCD (8%) |
| MN (12%) | LN (10%) | MCD (7%) | DN (6%) | DN (8%) |
| LN (10%) | Pauci-immune GN (8%) | IgAN/HSP (6%) | Pauci-immune GN (6%) | FSGS (7%) |
| Pauci-immune GN (5%) | DN (7%) | Pauci-immune GN (5%) | MCD (6%) | MN (7%) |
| MCD (4%) | MCD (6%) | DN (4%) | LN (5%) | TI disease (4%) |
| Alport syndrome/TBM (3%) | Amyloidosis (4%) | MPGN (3%) | TI disease (4%) | Infection-related GN (3%) |
| TMA (3%) | MPGN (4%) | MesProlif GN (2%) | Amyloidosis (2%) | Pauci-immune GN (3%) |
| MPGN (3%) | TMA (2%) | Infection-related GN (2%) | Alport syndrome/TBM (1%) | MPGN (2%) |