Nephrotic Syndrome: Causes

Pathogenesis (disease development)

In nephrotic syndrome, epithelial damage (podocytes and basement membrane) occurs as a result of the diseases, medications, or environmental exposures/intoxications (poisoning) listed below, resulting in an abnormally permeable membrane of the glomerulus (renal corpuscle). This leads to the symptoms described. In approximately 70% of cases, the cause of nephrotic syndrome is primary glomerular disease. The most common primary causes are membranous glomerulonephritis, minimal-change glomerulonephritis, and focal segmental glomerulosclerosis. The most common secondary causes are diabetes mellitus the amyloidosis and systemic lupus erythematosus (SSL).

Etiology (causes)

Biographic causes

  • Genetic burden
    • Genetic diseases
      • Alport syndrome (also called progressive hereditary nephritis) – genetic disorder with both autosomal dominant and autosomal recessive inheritance with malformed collagen fibers that can lead to nephritis (kidney inflammation) with progressive renal failure (kidney weakness), sensorineural hearing loss, and various eye diseases such as a cataract (cataract).
      • Sickle cell anemia (med.: Drepanocytosis; also sickle cell anemia, English : sickle cell anemia) – genetic disease with autosomal recessive inheritance, which affects the erythrocytes (red blood cells); it belongs to the group of hemoglobinopathies (disorders of hemoglobin; formation of an irregular hemoglobin, the so-called sickle cell hemoglobin, HbS).

Causes related to disease

Blood, blood-forming organs – immune system (D50-D90).

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Amyloidosis – extracellular (“outside the cell”) deposits of amyloids (degradation-resistant proteins) that can lead to cardiomyopathy (heart muscle disease), neuropathy (peripheral nervous system disease), and hepatomegaly (liver enlargement), among other conditions.
  • Diabetes mellitus
  • Hypothyroidism (underactive thyroid gland)

Circulatory system (I00-I99)

  • Hypertension (high blood pressure)

Infectious and parasitic diseases (A00-B99).

  • Schistosomiasis – worm disease (tropical infectious disease) caused by trematodes (sucking worms) of the genus Schistosoma (couple flukes).
  • Filariasis (infection with parasitic nematodes, the filariae).
  • Hepatitis B
  • Hepatitis C
  • HIV
  • Malaria
  • Poststreptococcal infection
  • Syphilis (venereal disease)
  • Toxoplasmosis (infectious disease caused by Toxoplasma gondii, which belongs to the protozoa (single-celled organisms)).
  • Trypanosome infections
  • Tuberculosis

Musculoskeletal system and connective tissue (M00-M99)

  • Rheumatoid arthritis – chronic inflammatory multisystem disease, usually manifested in the form of synovitis (inflammation of the synovial membrane).
  • Systemic lupus erythematosus (autoimmune disease).

Neoplasms – tumor diseases (C00-D48)

  • Hodgkin’s disease
  • Plasmocytoma (multiple myeloma) – systemic disease; belongs to the non-Hodgkin’s lymphomas of B lymphocytes. Multiple myeloma is associated with malignant (malignant) neoplasm of plasma cells and the formation of paraproteins

Genitourinary system (kidneys, urinary tract – sex organs) (N00-N99).

  • Acute interstitial nephritis – form of inflammation of the kidneys.
  • C1q nephropathy – rare form of inflammation of the renal corpuscles that occurs predominantly in children and young adults
  • Diabetic nephropathy – form of kidney disease caused by diabetes.
  • Glomerulonephritis (inflammation of the renal corpuscles).
    • Membranous glomerulonephritis (MGN)/membranous nephropathy
    • Membranoproliferative glomerulonephritis (MPGN)
    • Mesangial IgA glomerulonephritis (synonym: IgA nephropathy (IgAN))
    • Minimal Change Glomerulonephritis (MCGN).
  • Glomerulosclerosis – transformation of the renal corpuscles that can occur due to numerous diseases.
    • Diabetic glomerulosclerosis
    • Focal segmental glomerulosclerosis (FSGS) – group of chronic diseases of the kidney summarized, characterized by sclerosis (scarring) of the capillary loops of the glomerulus (renal corpuscles) visible under the light microscope.
  • Condition after renal vein thrombosis – occlusion of the renal vein by a blood clot.

Medication

  • Bisphosphonates (v .a. Palmindronate).
  • D-penicillamine (chelating agent)
  • Interferon
  • Lithium
  • NSAIDs (non-steroidal anti-inflammatory drugs)
  • Rifampicin (tuberculostatic drug)
  • See also under “Nephrotoxic drugs“.

Environmental pollution – intoxications (poisonings).

  • Cadmium
  • Gold
  • Palladium
  • Mercury