L3: Nephrotic Syndrome Flashcards
Def of Nephrotic syndrome
Etiology of Nephrotic syndrome
- Primary (idiopathic)
- Secondary
Etiology of Nephrotic syndrome
- Primary
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Etiology of Nephrotic syndrome
- Secondary
Etiology of Nephrotic syndrome
- Amyloid Nephropathy
▪ Multiple myeloma (AL amyloidosis) OR
▪ Chronic inflammatory disease as rheumatoid arthritis (AA amyloidosis).
CP of Nephrotic syndrome
- Proteinuria
- Hypoalbuminemia
- Edema
- Hyperlipidemia
- Lipoiduria
- Others (HTN & Hypo K & Ca)
CP of Nephrotic syndrome
- Proteinuria
Proteinuria in Nephrotic Syndrome
- Pathogenesis
① Damage to the endothelial surface, the glomerular basement membrane, or the podocytes.
② Loss of glomerular membrane negative charges causing albuminuria (as albumin has a net negative charge).
Proteinuria in Nephrotic Syndrome
- Presentation
frothy (foamy) urine due to proteins in urine.
Hypoalbuminemia in Nephrotic Syndrome
- Pathogenesis
① Most of albumin loss is due to urinary excretion.
② A substantial fraction of the filtered albumin is taken up by and catabolized in the proximal tubular cells.
③ Liver compensatory mechanism appears to be blunted in nephrotic syndrome
Edema in Nephrotic Syndrome
Edema in Nephrotic Syndrome
- Pathogenesis
Edema in Nephrotic Syndrome
- Characters
▪ In the beginning, it develops around the eyes and legs.
▪ Over time, the edema becomes generalized and leads to increasing weight and the development of ascites or pleural effusions.
Hyperlipidemia in Nephrotic Syndrome
Hyperlipidemia in Nephrotic Syndrome
- two most common lipid abnormalities in the nephrotic syndrome
▪ Hypercholesterolemia (mainly ⮅ LDL)
▪ Hypertriglyceridemia.
Hyperlipidemia in Nephrotic Syndrome
- Pathogenesis
Lipiduria in Nephrotic Syndrome
Accumulations of lipid in cellular debris and casts
BP & Electrolytes in Nephrotic Syndrome
- Hypertension: may occur but more common in nephritic syndrome.
- Electrolytes: Hypokalemia & Hypocalcemia (pseudo or true).
Complications of Nephrotic Syndrome
Complications of Nephrotic Syndrome
- Negative nitrogen balance
- Loss in lean body mass with often occurs in patients with marked proteinuria (may be masked by weight gain due to concurrently increasing edema).
Complications of Nephrotic Syndrome
- hypovolemia
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Complications of Nephrotic Syndrome
- Hypercoagulability & thromboembolism
particularly deep vein & renal vein thrombosis
Complications of Nephrotic Syndrome
- Infection
particularly with encapsulated bacteria as streptococcus pneumonia
Complications of Nephrotic Syndrome
- AKI
mostly pre-renal AKI due to hypovolemia
Complications of Nephrotic Syndrome
- CKD
◈ Most causes are associated with progressive kidney failure with the exception of MCD.
◈ The risk increases in proportion to the severity of the proteinuria.
Dx of Nephrotic Syndrome
- urine Studies
- Labs
- Bx
Dx of Nephrotic Syndrome
- urine Studies
Dx of Nephrotic Syndrome
- Labs
Labs in Nephrotic Syndrome
Labs in Nephrotic Syndrome
- KFTs
usually normal in uncomplicated cases.
Labs in Nephrotic Syndrome
- Serum Albumin
< 3.5 g/dl
Labs in Nephrotic Syndrome
- Lipid Profile
hyperlipidemia
Labs in Nephrotic Syndrome
- electrolytes
Decreased K+ & total Ca++
.
Labs in Nephrotic Syndrome
- Serology
▪ Tests for infections (e.g., HBV - HCV – HIV).
▪ Tests for Lupus (e.g., ANA - anti-dsDNA).
▪ Complement.
Biopsy in Nephrotic Syndrome
Biopsy in Nephrotic Syndrome
- In Peds?
- we often use an initial empiric trial of glucocorticoids because of the high incidence of MCD.
Biopsy in Nephrotic Syndrome
- In Adults
Biopsy is usually indicated to:
▪ Confirm the diagnosis
▪ Offer prognosis
▪ Inform management decisions
TTT of Nephrotic Syndrome
TTT of Nephrotic Syndrome
- TTT of Cause
Treatment should be dictated by the type of renal pathology causing nephrotic syndrome.
TTT of Nephrotic Syndrome
- TTT of Proteinuria
TTT of Nephrotic Syndrome
- TTT of Edema
① Dietary sodium restriction.
② Diuretics (e.g., Loop).
TTT of Nephrotic Syndrome
- TTT of Hyperlipidemia
TTT of Nephrotic Syndrome
- Vaccination
All patients should receive pneumococcal vaccination.
Done
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