## 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.
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