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FN: Nephrotic Syndrome Flashcards

1
Q

Triad

A

Proteinuria
Hypoalbuminaemia
Oedema
Hyperlipidaemia

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2
Q

Triad

A

Proteinuria
Hypoalbuminaemia
Oedema
Hyperlipidaemia

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3
Q

Proteinuria levels

A

PCR >300mg/mM or >3g/24hrs

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4
Q

Hypoalbuminaemia

A
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5
Q

Oedema

A

Periorbital
Genital
aScites
PEripheral - often intravascularly depleted with reduced JVP )cf. CFF)

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6
Q

Complications

A

Infection: reduced Ig, reduced complement activity
VTE: up to 40%
Hyperlipidaemia: raised cholesterol adn TG

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7
Q

Investigations

A

As for GN check lipids
Biopsy:
1. Biopsy all adults
2. Steroids 1st with children: mostly minimal change disease

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8
Q

Secondary to

A

Systemic disease
1. DM: glomerulosclerosis
SLE: membranous
Amyloidosis

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9
Q

Types

A

Minimal change glomerulonephritis
Membranous Nephropathy
FSGS
Membranoproliferative/Mesangiocapillary

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10
Q

Minimal change glomerulonephritis epi

A

Commonest in children

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11
Q

Minimal change glomerulonephritis assoc

A

URTI

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12
Q

Minimal change glomerulonephritis biopsy

A

normal light micro, fusion of podocytes on EM

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13
Q

Minimal change glomerulonephritis Rx

A

Steroids

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14
Q

Minimal change glomerulonephritis prognosis

A

1% ESRF

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15
Q

Membranous Nephropathy epi

A

20-30% of adult nephrotic syndrome

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16
Q

Membranous Nephropathy associations

A

Ca: lung, colon, breast
AI: SLE, thyroid disease
Infections: HBV
Drugs: Penicillamine, gold

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17
Q

Membranous Nephropathy biopsy shows

A

subepithelial immune complex depositis

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18
Q

Membranous Nephropathy Rx

A

immunosuppresion if renal failure declines

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19
Q

Membranous Nephropathy prognosis

A

40% spontaneous remission

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20
Q

FSGS ep

A

Commoner in Afro-caribeens

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21
Q

FSGS causes

A

Idiopathic or secondary : VUR, Bergers, SCD, HIV

22
Q

FSGS biopsy

A

focal scarring, IgM deposition

23
Q

FSGS Rx

A

Steroids or cyclophosphamide/ciclosporin

24
Q

FSGS prognosis

A

30-50% ESRF (may recur in transplants

25
``` Membranoproliferative/Mesangiocapillary GN epi May fall into which category Assoc Prognosis ```
Rare AMy be nephrotic (60%) or nephritis(30%) Association with HBV, endocarditis Prognosis is 50% ESRF
26
Management general of nephrotic syndrome
``` Monitor U+E, fluid balance and weight Treat the underlying causes Symptomatic/Complications RX: 1. Oedema: salt and fluid restrict + frusemide 2. Proteinuria: ACEi/ARA reduced proteinuria 3. Stains 4. WTE prophylaxis: tinzaparin 5. Rx HTN ```
27
Proteinuria levels
PCR >300mg/mM or >3g/24hrs
28
Hypoalbuminaemia
29
Oedema
Periorbital Genital aScites PEripheral - often intravascularly depleted with reduced JVP )cf. CFF)
30
Complications
Infection: reduced Ig, reduced complement activity VTE: up to 40% Hyperlipidaemia: raised cholesterol adn TG
31
Investigations
As for GN check lipids Biopsy: 1. Biopsy all adults 2. Steroids 1st with children: mostly minimal change disease
32
Secondary to
Systemic disease 1. DM: glomerulosclerosis SLE: membranous Amyloidosis
33
Types
Minimal change glomerulonephritis Membranous Nephropathy FSGS Membranoproliferative/Mesangiocapillary
34
Minimal change glomerulonephritis epi
Commonest in children
35
Minimal change glomerulonephritis assoc
URTI
36
Minimal change glomerulonephritis biopsy
normal light micro, fusion of podocytes on EM
37
Minimal change glomerulonephritis Rx
Steroids
38
Minimal change glomerulonephritis prognosis
1% ESRF
39
Membranous Nephropathy epi
20-30% of adult nephrotic syndrome
40
Membranous Nephropathy associations
Ca: lung, colon, breast AI: SLE, thyroid disease Infections: HBV Drugs: Penicillamine, gold
41
Membranous Nephropathy biopsy shows
subepithelial immune complex depositis
42
Membranous Nephropathy Rx
immunosuppresion if renal failure declines
43
Membranous Nephropathy prognosis
40% spontaneous remission
44
FSGS ep
Commoner in Afro-caribeens
45
FSGS causes
Idiopathic or secondary : VUR, Bergers, SCD, HIV
46
FSGS biopsy
focal scarring, IgM deposition
47
FSGS Rx
Steroids or cyclophosphamide/ciclosporin
48
FSGS prognosis
30-50% ESRF (may recur in transplants
49
``` Membranoproliferative/Mesangiocapillary GN epi May fall into which category Assoc Prognosis ```
Rare AMy be nephrotic (60%) or nephritis(30%) Association with HBV, endocarditis Prognosis is 50% ESRF
50
Management general of nephrotic syndrome
``` Monitor U+E, fluid balance and weight Treat the underlying causes Symptomatic/Complications RX: 1. Oedema: salt and fluid restrict + frusemide 2. Proteinuria: ACEi/ARA reduced proteinuria 3. Stains 4. WTE prophylaxis: tinzaparin 5. Rx HTN ```

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