2: Nephrotic Syndrome Flashcards
Where would abdominal pain be in nephrotic syndrome?
RUQ
While on oral steroids, what special management needs are present (5)?
Calcium and vitamin D supplementation Weight-bearing exercise Frequent eye exams No live virus vaccines Consider PPD prior to start of immunosuppressive medications
Primary or secondary nephrotic syndrome?
Associated with drug toxicity.
Secondary
Primary or secondary nephrotic syndrome?
Unrelated to systemic dz.
Primary
Nephrotic syndrome is caused by increased glomerular _____.
permeability
Primary or secondary nephrotic syndrome?
IgA or congenital association.
Secondary
Primary or secondary nephrotic syndrome?
Associated with malaria.
Secondary
What is the difference between selective and nonselective glomerular permeability?
Selective = albumin loss only Nonselective = most proteins lost
Primary or secondary nephrotic syndrome?
Associated with hep B.
Secondary
Primary or secondary nephrotic syndrome?
Biopsy shows moderate to severe morphologic abnormalities.
Secondary
Primary or secondary nephrotic syndrome?
Absence of gross hematuria or urinary casts.
Primary
Primary or secondary nephrotic syndrome?
Associated with allergens.
Secondary
Primary or secondary nephrotic syndrome?
Idiopathic in nature.
Primary
What protein numbers indicated nephrotic syndrome?
> 40 mg/m2/hr
Spot protein:creatinine ratio >1
Primary or secondary nephrotic syndrome?
10% of cases.
Secondary
When would BP be normal in nephrotic syndrome?
If hypovolemic.
Primary or secondary nephrotic syndrome?
Associated with SLE.
Secondary
Primary or secondary nephrotic syndrome?
Glomerular lesions on biopsy without inflammation and mild to no morphological abnormality.
Primary
Primary or secondary nephrotic syndrome?
Responds well to steroids.
Primary
Primary or secondary nephrotic syndrome?
Absent or transient microhematuria.
Primary
How does edema change throughout the day with nephrotic syndrome?
More periorbital in the morning and dependent in the evening.
What do diagnostics show in nephrotic syndrome (5)?
Protein 2+ or higher Hyaline and fine granular casts Microhematuria (33%) Elevated specific gravity (concentrated) Fat bodies in urine
Primary or secondary nephrotic syndrome?
Associated with syphilis.
Secondary
Primary or secondary nephrotic syndrome?
Normal vascular volume despite edema.
Primary
What steroid and dose is usually used in nephrotic syndrome?
Prednisone
2 mg/kg/day, max 60 mg until remission (typically 4-6 weeks), then taper.
Primary or secondary nephrotic syndrome?
Associated with HIV.
Secondary
What is the management of nephrotic syndrome (11)?
- Most respond to steroids.
- Remission/relapse pattern.
- Followed by nephrology.
- No activity limitations.
- Low salt diet initially (high protein and low cholesterol).
- Diuretics and albumin replacement if needed.
- Home BP monitoring.
- Home proteinuria monitoring.
- Routine vaccines during remissions.
- Pneumococcal and flu vaccines.
- Monitor and prompt treatment of infx.
If your patient presents with edema, low urine production, anorexia, and recent infx, you might suspect what?
Nephrotic syndrome. It presents with edema (esp of eyes, hands, feet, and legs), low urine production, anorexia, paleness, listlessness, n/d, RUQ pain, hx of recent infx, respiratory difficulty (ascites, effusion, pneumonia), HTN, growth failure, muscle wasting.
Primary or secondary nephrotic syndrome?
Usually occurs in children 1-7 yo.
Primary
Primary or secondary nephrotic syndrome?
Normal creatinine, complement, and ANA.
Primary
Primary or secondary nephrotic syndrome?
Associated with Henoch-Schonlein purpura.
Secondary
Nephrotic syndrome leads to what (3)?
Hypoalbuminemia
Edema
Hyperlipidemia
This is caused by excessive protein loss into urine.
Nephrotic syndrome
Why does nephrotic syndrome lead to hyperlipidemia and lipiduria?
Liver increases its synthesis of protein.
Primary or secondary nephrotic syndrome?
80-90% of cases
Primary
