9. NephrOtic Syndrome Flashcards
What is the diagnostic criteria of Nephrotic Syndrome?
Proteinuria >3g/day
Hypoalbuminemia <30g/dL
Oedema
High Cholesterol
What can we use to assess proteinuria?
- Urine dipstick
- Bedside test
- 24 Hour Urine Collection (GOLD)
What can be tested on the bedside for Proteinuria?
- Blood
- Protein
- Leukocytes
- Nitrites
- pH
On a urine dipstick, what does a protein value of 4+ represent?
> 1000 mg/dL
On a urine dipstick, what does a protein value of Trace represent?
15-30 mg/dL
What is the total creatinine excretion rate?
1000 mg/day (8.8mmol)
How does Oedema arise in Nephrotic Syndrome according to the Underfill hypothesis?
- Hypoalbuminemia drops intravascular colloid osmotic pressure
- Intravascular volume drops due to osmosis
- RAAS will retain sodium and water –> Oedema
What is the role of Colloid oncotic pressure
- COP will draw fluid from interstitial space back to the capillaries
How does Oedema arise in Nephrotic Syndrome according to the Overfill hypothesis?
Primary Sodium Retention
- Increased Na/K pump in the collecting tubule
*What 7 investigations can be done to check for Nephrotic Syndrome?
- Urine
- Protein/Creatinine Ratio
- Microscopy
- Blood investigation
- FBC
- Clotting
- Urea + Electrolytes
- LFTs - Imaging
- US Renal Tract
- Renal Biopsy
What can cause Nephrotic Syndrome?
- Minimal Change Disease
- Focal Segmental Glomerulosclerosis
- Membranous Nephropathy
- Diabetic Nephropathy
- Amyloid Deposition
- Congenital
What can you see in Minimal Change Disease
- Fusion of Podocytes on EM
- Normal Light Microscopy
- Absence of Microscopic Haematuria
What can you see in FSGS?
Focal: Not all glomeruli affected
Segmental: Part of Glom is sclerosed
What can be seen in Membranous Nephropathy?
- Common cause of NS in non-diabetic adults
- Thick Capillary Loops
- Subepithelial Immunoglobulin deposition
What is the primary cause of Membranous Nephropathy?
Autoimmune
What is the secondary cause of Membranous Nephropathy?
- SLE/Lupus Nephritis
- Drugs
- Malignancy
- Infection
What drugs can be the secondary cause of Membranous Nephropathy?
- Penicillamine
- Gold
- Anti-TNF
What infections can be the secondary cause of Membranous Nephropathy?
- HepB
- HepC
- HIV
- Malaria
- Syphillis
- Sarcoidosis
What complications can arise from Nephrotic Syndrome?
- Childhood infection
- Thromboembolism
- Renal impairment
- Dysplipidemia
How can we manage Nephrotic Syndrome?
- Treating Oedema
- Reducing Proteinuria
- Anti-coagulation
- Immunisation
- Nutrition
- Statins for Dyslipidemia
How can we TREAT oedema?
- Salt and water restriction
- 1 Litre a day - Loop Diuretics -> Thiazides -> Aldosterone antagonists
How can we Reduce Proteinuria?
- ACEI
2. ARB
