In a series of 100 adult Indian patients presenting with nephrotic syndrome, kidney biopsies were performed. Which of the following is the most common histological pattern of glomerulonephritis causing nephrotic syndrome in this population?

Question

Accepted Answer

C. Membranous nephropathy. ## Most Common Cause of Nephrotic Syndrome in Adults (India)

**Key Point:** Membranous nephropathy remains the most common cause of nephrotic syndrome in adult Indian populations, accounting for approximately 30–40% of biopsy-proven cases.

### Epidemiology in India

| Diagnosis | Frequency (%) | Age Group | Key Feature |
| --- | --- | --- | --- |
| Membranous nephropathy | 30–40 | Adults (>18 yrs) | Spike and dome EM |
| Minimal change disease | 15–25 | Children (2–6 yrs) | Normal EM |
| FSGS | 10–15 | Adolescents/young adults | Segmental sclerosis |
| MPGN | 8–12 | Mixed age | Subendothelial deposits |
| Proliferative GN | 5–10 | Children/young adults | Endocapillary proliferation |

**High-Yield:** In Indian populations, secondary causes of MN are more prevalent than in Western cohorts:
- Infections: HBV (10–15%), HCV, syphilis, tuberculosis
- Malignancy: gastric, lung, colorectal cancers
- Autoimmune: SLE (lupus nephritis Class V)
- Drugs: NSAIDs (common due to over-the-counter use)

### Why MN Dominates in Adult Nephrotic Syndrome

1. **Age shift:** Minimal change disease (most common in children) becomes rare after age 10–12 years
2. **Cumulative exposure:** Adults have longer exposure to infections, drugs, and malignancy
3. **Immune complex deposition:** Chronic antigenic stimulation (HBV, HCV) drives subepithelial immune complex formation
4. **Autoimmunity:** Primary MN (PLA2R-positive) increases with age

### Clinical Pearls

**Clinical Pearl:** Always screen for secondary causes in Indian patients with MN:
- HBsAg and anti-HCV serology
- Chest X-ray and age-appropriate cancer screening
- ANA and anti-dsDNA for SLE
- Syphilis serology (RPR/VDRL)

**Mnemonic: SHINE** — **S**econdary causes (HBV, HCV, malignancy), **H**istology (spike and dome), **I**mmune deposits (IgG, C3), **N**ephrotic range proteinuria, **E**lectron microscopy — features of **M**embranous **N**ephropathy.

Answer

A. Membranoproliferative glomerulonephritis

Answer

B. Minimal change disease

Answer

D. Diffuse proliferative glomerulonephritis

In a series of 100 adult Indian patients presenting with nephrotic syndrome, kidney biopsies were performed. Which of the following is the most common histological pattern of glomerulonephritis causing nephrotic syndrome in this population?

Explanation

Most Common Cause of Nephrotic Syndrome in Adults (India)

Epidemiology in India

Why MN Dominates in Adult Nephrotic Syndrome

Clinical Pearls

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Diagnosis	Frequency (%)	Age Group	Key Feature
Membranous nephropathy	30–40	Adults (>18 yrs)	Spike and dome EM
Minimal change disease	15–25	Children (2–6 yrs)	Normal EM
FSGS	10–15	Adolescents/young adults	Segmental sclerosis
MPGN	8–12	Mixed age	Subendothelial deposits
Proliferative GN	5–10	Children/young adults	Endocapillary proliferation