Nephrotic Syndrome Classification and Management

Introduction to Nephrotic Syndrome

The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines propose a novel classification of Focal and Segmental Glomerulosclerosis (FSGS) into four subcategories, including primary, genetic, secondary, and undetermined cause FSGS 2, 4

The American Society of Nephrology recommends that nephrotic syndrome be classified into three primary histological types: minimal change disease, FSGS, and membranous nephropathy, with varying frequencies depending on patient age and ethnicity 1, 2
The National Kidney Foundation states that minimal change disease is the most common cause of nephrotic syndrome in children, and in adults who respond to glucocorticoids, long-term renal survival is excellent 3

The European Renal Association suggests that secondary causes of nephrotic syndrome include systemic diseases such as lupus erythematosus, diabetes mellitus, and amyloidosis, as well as infections like hepatitis B and C, and HIV 2, 4, 5
The International Society of Nephrology recommends that certain neoplasias, such as solid tumors and hematological malignancies, be considered as potential causes of nephrotic syndrome 2, 5

The KDIGO guidelines recommend that adults with nephrotic syndrome undergo renal biopsy to confirm diagnosis, as FSGS and membranous nephropathy are more common in this population 4

The American College of Cardiology states that patients with nephrotic syndrome have a significant risk of thrombosis, infections, and accelerated coronary disease 2
The National Institute of Diabetes and Digestive and Kidney Diseases reports that patients with proteinuria >3.8 g/day have a 35% risk of end-stage renal disease within 2 years 2, 5