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Nephrol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Many pathological processes can disrupt the integrity of the glomerular capillary wall and cause a massive leakage of protein, resulting in nephrotic syndrome (NS). Clinical parameters such as age, sex, renal function, presence of diabetes, and how NS is defined influence the spectrum of underlying diseases. In this study, we examine how these parameters interact.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Age, sex, hematuria, proteinuria, plasma creatinine plasma albumin levels, and final diagnosis were retrieved for all adult patients with NS as an indication for biopsy and\/or massive albuminuria in conjunction with low plasma albumin from the biopsy module of the Swedish Renal Registry (SRR) between 2014 and 2019.\u00a0A basic calculator was developed to demonstrate the importance of clinical presentation in relation to the likelihood of having a specific diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 913 unique patients were included in the study. Diabetic nephropathy (DN) and membranous nephropathy (MN) (both found in 17% of patients) were the most common diagnoses. With a stringent definition of NS, MN and minimal change nephropathy (MCN) increased in proportion. Among the cohort as a whole, MCN was the most frequent diagnosis in women and those &amp;lt;\u00a050 years of age (found in 21% and 17%, respectively). In the case of patients aged between 50 and 70 years, those with chronic kidney disease stage 4, and those with negative dipstick tests for hematuria, the most common underlying disease was DN (in 23%, 30%, and 21% of cases, respectively). Among those with high-grade hematuria (dipstick grade 3 or 4), membranoproliferative glomerulonephritis was the most common diagnosis (14%), closely followed by IgA nephropathy (13%). Focal segmental glomerulosclerosis (9.7%) was less common than in many comparable studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Clinical parameters have a profound impact on the likelihood of different diagnoses in adult patients with NS. Differences in clinical practice and study inclusion criteria may be more important than genetic background and environmental factors when explaining differences between studies in different parts of the world.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneph.2023.1026864","type":"journal-article","created":{"date-parts":[[2023,3,17]],"date-time":"2023-03-17T04:47:25Z","timestamp":1679028445000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Causes of nephrotic syndrome in Sweden: The relevance of clinical presentation and demographics"],"prefix":"10.3389","volume":"3","author":[{"given":"Anneli","family":"J\u00f6nsson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Hellmark","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M\u00e5rten","family":"Segelmark","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Forsberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl","family":"Dreja","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199804233381707","article-title":"The nephrotic syndrome","volume":"338","author":"Orth","year":"1998","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39576.709711.80","article-title":"Nephrotic syndrome in adults","volume":"336","author":"Hull","year":"2008","journal-title":"BMJ"},{"key":"B3","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1111\/nep.12559","article-title":"Epidemiology of biopsy-proven glomerulonephritis in Queensland adults","volume":"21","author":"Jegatheesan","year":"2016","journal-title":"Nephrol (Carlton)"},{"key":"B4","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1111\/j.1523-1755.2004.00833.x","article-title":"Clinicopathologic correlations of renal pathology in Spain","volume":"66","author":"Rivera","year":"2004","journal-title":"Kidney Int"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000444026","article-title":"Renal biopsy in 2015\u2013from epidemiology to evidence-based indications","volume":"43","author":"Fiorentino","year":"2016","journal-title":"Am J Nephrol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1111\/jorc.12307","article-title":"Persons' experiences of suffering from nephrotic syndrome","volume":"46","author":"J\u00f6nsson","year":"2020","journal-title":"J Ren Care"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.4103\/1319-2442.256855","article-title":"Epidemiologic data of biopsy-proven renal diseases: Experience from a single center in south India","volume":"30","author":"Bandi","year":"2019","journal-title":"Saudi J Kidney Dis Transpl"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1159\/000336307","article-title":"Renal biopsy in very elderly patients: Data from the Spanish registry of glomerulonephritis","volume":"35","author":"Verde","year":"2012","journal-title":"Am J Nephrol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/14.8.1889","article-title":"The epidemiology and prognosis of glomerulonephritis in Denmark 1985-1997","volume":"14","author":"Heaf","year":"1999","journal-title":"Nephrol Dial Transplant"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.10871016","article-title":"Temporal and demographic trends in glomerular disease epidemiology in the southeastern united states, 1986-2015","volume":"12","author":"O'Shaughnessy","year":"2017","journal-title":"Clin J Am Soc Nephrol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfh521","article-title":"The Czech registry of renal biopsies. occurrence of renal diseases in the years 1994-2000","volume":"19","author":"Rychl\u00edk","year":"2004","journal-title":"Nephrol Dial Transplant"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfq302","article-title":"A 5-year survey of biopsy proven kidney diseases in Lebanon: Significant variation in prevalence of primary glomerular diseases by age, population structure and consanguinity","volume":"25","author":"Karnib","year":"2010","journal-title":"Nephrol Dial Transplant"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/12.3.418","article-title":"Survey of the Italian registry of renal biopsies. 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