2: Nephrotic Syndrome Flashcards
What is the mnemonic to remember causes of nephrotic syndrome
LADFMMM
Lupus nephritis Amyloidosis Diabetic neprhopathy Focal segmental glomerulonephritis Membranous glomerunonpehritis Minimal change disease Membranous neprhopathy
What is the triad of symptoms in nephrotic syndrome
Oedema
Hypoalbuminaemia
Proteinuria
What level of protein defines proteinuria
<3.5g/24hours
How does proteinuria cause urine to present
Frothy urine
What defines hypoalbuminaemia
<30g/L
Why does nephrotic syndrome cause hyperlipidaemia
Nephrotic syndrome causes lack of protein - this leads to over production of lipids by the liver
Why is there low total T4 levels in nephrotic syndrome
Decrease in thyroid binding globulin
When is focal segmental glomerulonephritis the most common cause of nephrotic syndrome
Afro-Carribean patients
What is primary focal segmental glomerulonephritis
Idiopathic
What is secondary focal segmental glomerulonephritis
Secondary to another disease such as sickle cell or HIV
How does focal segmental glomerulonephritis present clinically
Nephrotic:
- Oedema
- Proteinuria
- Hypoalbuminaemia
What is the most common cause of nephrotic syndrome in adults
Membranous nephropathy
What is membranous nephropathy
Inflammation of glomerulus
What causes primary membranous nephropathy
Idiopathic: due to anti- phospholipase A2 receptor antibodies
What causes secondary primary membranous nephropathy
Underlying disease:
- Hep B and C
- SLE
- Tumours
How does membranous nephropathy present clinically
Nephrotic syndrome
What is characteristic of membranous nephropathy on electron microscopy
Spike and Dome appearance
How is primary membranous nephropathy managed
Corticosteroids
What is membranoproliferative glomerulonephritis
Deposition of immune complexes in the glomerulus that causing inflammation altering kidney structure and function
What is type I membranoproliferative glomerulonephritis
Antigen-antibody complexes which activate complement
What pattern is present in type I membranoproliferazive glomerulonephritis
Tram-track
What pattern is present in type II membranoproliferative glomerulonephritis
Deposition of complement (without immune complexes) in the basement membrane
How can membroproliferative glomerulonephritis present
Nephrotic or nephritic
How will complement appear in membranoproliferazive glomerulonephritis
Low
What is the most common cause of nephrotic syndrome in children
Minimal change disease
What are 5 causes of minimal change disease
- Idiopathic
- Medication (NSAID, Rifampicin)
- Hodgkin Lymphoma
- Thymoma
- Infectious mononucleosis
How does minimal change disease present
Nephrotic
Why is it called minimal change disease
Unable to visualise changes on light microscopy
How is minimal change disease managed
Steroids
If resistant to steroids how is minimal change disease managed
Cyclophosphamide
What are patients with nephrotic syndrome at risk of
VTE
Why are patients with nephrotic syndrome at increased risk of VTE
Due to loss of antithrombin-3, leaving individuals in a pro-coagulant state
How is risk of VTE in nephrotic syndrome reduced
LMWH
