2.4. Glomerulonephritis - Nephrotic Syndrome Flashcards
What are the three conditions which cause Nephrotic Syndrome?
- Minimal Change Disease
- Focal Glomerulosclerosis
- Membranous Nephropathy
What is the commonest cause of Nephrotic Syndrome in children?
Minimal Change Disease
What does Focal Glomerulosclerosis cause?
Death to Podocytes, which can progress to renal failure over 2-3 years
How severe are the Nephrotic Syndrome Symptoms caused by Focal Glomerulosclerosis?
Severe
Does a transplant cure Focal Glomerulosclerosis?
No, it can re-occur after transplantation
What is the commonest cause of Nephrotic Syndrome in Adults?
Membranous Nephropathy
What is the Aetiology of Membranous Nephropathy?
This is unknown but malignancy is suspected
What is the pathology of Membranous Nephropathy?
- The Basement Membrane is abnormally thickened due to the Deposition of IgG on the Basal Lamina (closest to the Podocyte)
- The IgG cannot pass through here however to get into the Urine so holes are punches in the Punched in the Basal Lamina / Podocyte due to the Compliment Cascade C3
- This causes a leaky filter and Nephrotic Syndrome can occur
What are the Clinical Features of Nephrotic Syndrome?
- Oedema
- Proteinuria
- Hypoalbuminaemia
- Hyperlipidaemia
- Hypercoagulability
- Increased Risk of Infection
In what condition would a Sudden Onset of Oedema be associated with?
Minimal Change Disease
Why does the Oedema / Hypoalbuminaemia occur?
Due to the loss of Albumin, which maintains the Oncotic Pressure, through the holes punched in the Glomeruli
Why does Proteinuria occur?
Do to protein leaking through the Glomeruli Filter into the Tubule
Why does Hyperlipidaemia occur?
- The liver tries to compensate for the loss of Albumin
2. As a side effect there is an increase in the production of Lipids
Why does Hypercoagulability occur?
Due to the loss of Anti-Clotting Factors
What is the Significant Risk associated with Hypercoagulability?
DVT
Why is there an increased risk of infection?
Due to the loss of immunoglobulins into the Urine
What investigation is necessary in Nephrotic Syndrome?
Renal Biopsy with Electron Microscopy?
Why is the Electron Microscopy needed?
As there is no proliferation, the initial view will look fine.
However, on close inspection with an Electron Microscope, problems will be seen
What are the three categories of treatments for Nephrotic Syndrome?
- Specific Management
- Treatment of Oedema
- Prophylaxis against Complcations
What is included in Specific Management of Nephrotic Syndrome?
- Steroids
- ACE inhibitors
- Dialysis
What is the Advantage / Disadvantage of Steroids used in the Specific Management of Nephrotic Syndrome?
Advantage - This will stop the proteinuria
Disadvantage - This leaves you at a higher risk of Infections and DVT
What is the purpose of the ACE inhibitors?
To reduce the Proteinuria
When is Dialysis used?
In End-Stage Renal Failure
What is included in the Treatment of Oedema in Nephrotic Syndrome?
- Fluid / Sodium Restriction
- High Protein Diet
- Loop Diuretics
- Albumin Infusion
Why does Fluid / Sodium Restriction help?
This prevents the pulling of even more fluid out of cells
Why does a high protein diet help?
This restores some of the protein lost due to the proteinuria
When are Loop Diuretics / An Albumin Infusion used?
When the Oedema is resistant
What is included in the Prophylaxis against Complications?
- Penicillin - Infection
2. Heparin - Thrombosis
