2: Nephrotic Syndrome

Question 1

Where would abdominal pain be in nephrotic syndrome?

Answer 1

RUQ

Question 2

While on oral steroids, what special management needs are present (5)?

Answer 2

Calcium and vitamin D supplementation
Weight-bearing exercise
Frequent eye exams
No live virus vaccines
Consider PPD prior to start of immunosuppressive medications

Question 3

Primary or secondary nephrotic syndrome?

Associated with drug toxicity.

Answer 3

Secondary

Question 4

Primary or secondary nephrotic syndrome?

Unrelated to systemic dz.

Answer 4

Primary

Question 5

Nephrotic syndrome is caused by increased glomerular _____.

Answer 5

permeability

Question 6

Primary or secondary nephrotic syndrome?

IgA or congenital association.

Answer 6

Secondary

Question 7

Primary or secondary nephrotic syndrome?

Associated with malaria.

Answer 7

Secondary

Question 8

What is the difference between selective and nonselective glomerular permeability?

Answer 8

Selective = albumin loss only
Nonselective = most proteins lost

Question 9

Primary or secondary nephrotic syndrome?

Associated with hep B.

Answer 9

Secondary

Question 10

Primary or secondary nephrotic syndrome?

Biopsy shows moderate to severe morphologic abnormalities.

Answer 10

Secondary

Question 11

Primary or secondary nephrotic syndrome?

Absence of gross hematuria or urinary casts.

Answer 11

Primary

Question 12

Primary or secondary nephrotic syndrome?

Associated with allergens.

Answer 12

Secondary

Question 13

Primary or secondary nephrotic syndrome?

Idiopathic in nature.

Answer 13

Primary

Question 14

What protein numbers indicated nephrotic syndrome?

Answer 14

> 40 mg/m2/hr

Spot protein:creatinine ratio >1

Question 15

Primary or secondary nephrotic syndrome?

10% of cases.

Answer 15

Secondary

Question 16

When would BP be normal in nephrotic syndrome?

Answer 16

If hypovolemic.

Question 17

Primary or secondary nephrotic syndrome?

Associated with SLE.

Answer 17

Secondary

Question 18

Primary or secondary nephrotic syndrome?

Glomerular lesions on biopsy without inflammation and mild to no morphological abnormality.

Answer 18

Primary

Question 19

Primary or secondary nephrotic syndrome?

Responds well to steroids.

Answer 19

Primary

Question 20

Primary or secondary nephrotic syndrome?

Absent or transient microhematuria.

Answer 20

Primary

Question 21

How does edema change throughout the day with nephrotic syndrome?

Answer 21

More periorbital in the morning and dependent in the evening.

Question 22

What do diagnostics show in nephrotic syndrome (5)?

Answer 22

Protein 2+ or higher
Hyaline and fine granular casts
Microhematuria (33%)
Elevated specific gravity (concentrated)
Fat bodies in urine

Question 23

Primary or secondary nephrotic syndrome?

Associated with syphilis.

Answer 23

Secondary

Question 24

Primary or secondary nephrotic syndrome?

Normal vascular volume despite edema.

Answer 24

Primary

Question 25

What steroid and dose is usually used in nephrotic syndrome?

Answer 25

Prednisone

2 mg/kg/day, max 60 mg until remission (typically 4-6 weeks), then taper.

Question 26

Primary or secondary nephrotic syndrome?

Associated with HIV.

Answer 26

Secondary

Question 27

What is the management of nephrotic syndrome (11)?

Answer 27

1. Most respond to steroids.
2. Remission/relapse pattern.
3. Followed by nephrology.
4. No activity limitations.
5. Low salt diet initially (high protein and low cholesterol).
6. Diuretics and albumin replacement if needed.
7. Home BP monitoring.
8. Home proteinuria monitoring.
9. Routine vaccines during remissions.
10. Pneumococcal and flu vaccines.
11. Monitor and prompt treatment of infx.

Question 28

If your patient presents with edema, low urine production, anorexia, and recent infx, you might suspect what?

Answer 28

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.

Question 29

Primary or secondary nephrotic syndrome?

Usually occurs in children 1-7 yo.

Answer 29

Primary

Question 30

Primary or secondary nephrotic syndrome?

Normal creatinine, complement, and ANA.

Answer 30

Primary

Question 31

Primary or secondary nephrotic syndrome?

Associated with Henoch-Schonlein purpura.

Answer 31

Secondary

Question 32

Nephrotic syndrome leads to what (3)?

Answer 32

Hypoalbuminemia
Edema
Hyperlipidemia

Question 33

This is caused by excessive protein loss into urine.

Answer 33

Nephrotic syndrome

Question 34

Why does nephrotic syndrome lead to hyperlipidemia and lipiduria?

Answer 34

Liver increases its synthesis of protein.

Question 35

Primary or secondary nephrotic syndrome?

80-90% of cases

Answer 35

Primary