JAN HERRMAN, M.D.
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To the editor: Levey and colleagues (1) have emphasized the need for ongoing reevaluation of the way in which we approach patients who have nephrotic-range proteinuria. However, they have omitted several critical elements from their equations.
First, a case of nephrotic syndrome is considered idiopathic only after an exhaustive attempt to identify an underlying cause. Once we have excluded the easily identifiable causes by history, physical examination, and ancillary testing, we decide on the need for renal biopsy. The search for a cause, however, does not stop once the biopsy has been done. The particular histopathologic finding often necessitates additional
HERRMAN J. The Idiopathic Nephrotic Syndrome and Renal Biopsy. Ann Intern Med. ;108:774–775. doi: 10.7326/0003-4819-108-5-774
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Published: Ann Intern Med. 1988;108(5):774-775.
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