Fast Five Quiz: How Much Do You Know About Nephrotic Syndrome?

Vecihi Batuman, MD

Disclosures

July 19, 2017

Phospholipase A2 receptor is a cell surface transmembrane receptor expressed on the surface of podocytes; 75% of patients with idiopathic membranous nephropathy have autoantibodies directed against phospholipase A2 receptor. Levels of this antibody have a strong correlation with clinical disease activity and thus help in monitoring disease activity and treatment efficacy.Absence of these antibodies may suggest secondary membranous nephropathy, such as that associated with cancers.

During treatment, the levels of the antibodies generally decline before remission of proteinuria. After treatment, about half of patients who are phospholipase A2 receptor‒negative remain in remission for 5 years, but those who remain phospholipase A2 receptor‒positive typically relapse in just 2 years. Use of the phospholipase A2 receptor antibody test has changed the diagnosis and treatment of idiopathic membranous nephropathy.

Serum creatinine levels are in the normal range in uncomplicated nephrotic syndrome, such as that occurring in minimal-change nephropathy. In children, the serum creatinine level will be lower than it is in adults. The normal adult serum creatinine level is approximately 1 mg/dL, whereas that of a child aged 5 years will be about 0.5 mg/dL. Values higher than this in children indicate reduced kidney function.

The serum albumin level is typically low in nephrotic syndrome, below the normal range of 3.5-4.5 g/dL—usually < 3 g/dL.

Tests for previous streptococcal infection, such as antistreptolysin O, are not usually indicated for nephrotic syndrome because postinfectious glomerulonephritis usually causes a nephritic rather than a nephrotic syndrome.

For more on the workup of nephrotic syndrome, read here.

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