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Difficulty: MediumNephrology

Match each clinical presentation and disease association to the most likely corresponding nephrotic syndrome etiology.

  • An adult patient with a solid tumor malignancy (e.g., lung carcinoma) who exhibits thickened glomerular capillary loops on biopsyMembranous nephropathy
  • A patient of African descent presenting with severe proteinuria in the setting of untreated HIV infection; biopsy shows sclerosis in portions of some glomeruliFocal segmental glomerulosclerosis (FSGS)
  • A patient with chronic Hepatitis C infection who develops mixed cryoglobulinemia and shows a 'tram-track' appearance of the glomerular basement membraneMembranoproliferative glomerulonephritis (MPGN)
  • A young child who develops sudden-onset massive periorbital edema and hypoalbuminemia following a mild viral upper respiratory tract infectionMinimal change disease

Answer

Solid tumors correlate with Membranous nephropathy, HIV infection with FSGS, Hepatitis C with MPGN, and childhood post-viral onset with Minimal change disease.
Each type of nephrotic syndrome has classic epidemiological and systemic associations. Identifying these triggers (e.g., solid tumors, specific viral infections, or age demographics) is critical for determining the specific glomerular pathology and guiding subsequent management.

Step-by-Step Solution

1
Analyze the adult presentation with a solid tumor and thickened capillary loops.
This profile maps to Membranous nephropathy.
Membranous nephropathy is the classic nephrotic syndrome paraneoplastic manifestation of solid organ malignancies.
2
Analyze the patient with HIV and focal sclerotic lesions.
This profile maps to Focal segmental glomerulosclerosis (FSGS).
HIV-associated nephropathy (HIVAN) is a highly specific, rapidly progressive form of collapsing FSGS.
3
Analyze the Hepatitis C patient with tram-track glomerular splitting.
This profile maps to Membranoproliferative glomerulonephritis (MPGN).
Hepatitis C drives immune-complex deposition in the glomeruli, characteristic of type I MPGN.
4
Analyze the pediatric patient with post-viral edema.
This profile maps to Minimal change disease.
The sudden onset of pure nephrotic syndrome in a child after a viral illness is the hallmark of Minimal change disease.

Key Concept

Secondary causes and systemic associations of nephrotic syndromes
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Topics

Nephrology

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