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Y4R3 - Medicine II 🩺 > L3: Nephrotic Syndrome > Flashcards

L3: Nephrotic Syndrome Flashcards

1
Q

Def of Nephrotic syndrome

A
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2
Q

Etiology of Nephrotic syndrome

A
  • Primary (idiopathic)
  • Secondary
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3
Q

Etiology of Nephrotic syndrome

  • Primary
A

…

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4
Q

Etiology of Nephrotic syndrome

  • Secondary
A
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5
Q

Etiology of Nephrotic syndrome

  • Amyloid Nephropathy
A

▪ Multiple myeloma (AL amyloidosis) OR

▪ Chronic inflammatory disease as rheumatoid arthritis (AA amyloidosis).

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6
Q

CP of Nephrotic syndrome

A
  • Proteinuria
  • Hypoalbuminemia
  • Edema
  • Hyperlipidemia
  • Lipoiduria
  • Others (HTN & Hypo K & Ca)
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7
Q

CP of Nephrotic syndrome

  • Proteinuria
A
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8
Q

Proteinuria in Nephrotic Syndrome

  • Pathogenesis
A

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).

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9
Q

Proteinuria in Nephrotic Syndrome

  • Presentation
A

frothy (foamy) urine due to proteins in urine.

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10
Q

Hypoalbuminemia in Nephrotic Syndrome

  • Pathogenesis
A

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

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11
Q

Edema in Nephrotic Syndrome

A
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12
Q

Edema in Nephrotic Syndrome

  • Pathogenesis
A
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13
Q

Edema in Nephrotic Syndrome

  • Characters
A

▪ 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.

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14
Q

Hyperlipidemia in Nephrotic Syndrome

A
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15
Q

Hyperlipidemia in Nephrotic Syndrome

  • two most common lipid abnormalities in the nephrotic syndrome
A

▪ Hypercholesterolemia (mainly ⮅ LDL)

▪ Hypertriglyceridemia.

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16
Q

Hyperlipidemia in Nephrotic Syndrome

  • Pathogenesis
A
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17
Q

Lipiduria in Nephrotic Syndrome

A

Accumulations of lipid in cellular debris and casts

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18
Q

BP & Electrolytes in Nephrotic Syndrome

A
  • Hypertension: may occur but more common in nephritic syndrome.
  • Electrolytes: Hypokalemia & Hypocalcemia (pseudo or true).
19
Q

Complications of Nephrotic Syndrome

A
20
Q

Complications of Nephrotic Syndrome

  • Negative nitrogen balance
A
  • Loss in lean body mass with often occurs in patients with marked proteinuria (may be masked by weight gain due to concurrently increasing edema).
21
Q

Complications of Nephrotic Syndrome

  • hypovolemia
A

…

22
Q

Complications of Nephrotic Syndrome

  • Hypercoagulability & thromboembolism
A

particularly deep vein & renal vein thrombosis

23
Q

Complications of Nephrotic Syndrome

  • Infection
A

particularly with encapsulated bacteria as streptococcus pneumonia

24
Q

Complications of Nephrotic Syndrome

  • AKI
A

mostly pre-renal AKI due to hypovolemia

25
Q

Complications of Nephrotic Syndrome

  • CKD
A

◈ Most causes are associated with progressive kidney failure with the exception of MCD.

◈ The risk increases in proportion to the severity of the proteinuria.

26
Q

Dx of Nephrotic Syndrome

A
  • urine Studies
  • Labs
  • Bx
27
Q

Dx of Nephrotic Syndrome

  • urine Studies
A
28
Q

Dx of Nephrotic Syndrome

  • Labs
A
29
Q

Labs in Nephrotic Syndrome

A
30
Q

Labs in Nephrotic Syndrome

  • KFTs
A

usually normal in uncomplicated cases.

31
Q

Labs in Nephrotic Syndrome

  • Serum Albumin
A

< 3.5 g/dl

32
Q

Labs in Nephrotic Syndrome

  • Lipid Profile
A

hyperlipidemia

33
Q

Labs in Nephrotic Syndrome

  • electrolytes
A

Decreased K+ & total Ca++
.

34
Q

Labs in Nephrotic Syndrome

  • Serology
A

▪ Tests for infections (e.g., HBV - HCV – HIV).
▪ Tests for Lupus (e.g., ANA - anti-dsDNA).
▪ Complement.

35
Q

Biopsy in Nephrotic Syndrome

A
36
Q

Biopsy in Nephrotic Syndrome

  • In Peds?
A
  • we often use an initial empiric trial of glucocorticoids because of the high incidence of MCD.
37
Q

Biopsy in Nephrotic Syndrome

  • In Adults
A

Biopsy is usually indicated to:
▪ Confirm the diagnosis
▪ Offer prognosis
▪ Inform management decisions

38
Q

TTT of Nephrotic Syndrome

A
39
Q

TTT of Nephrotic Syndrome

  • TTT of Cause
A

Treatment should be dictated by the type of renal pathology causing nephrotic syndrome.

40
Q

TTT of Nephrotic Syndrome

  • TTT of Proteinuria
A
41
Q

TTT of Nephrotic Syndrome

  • TTT of Edema
A

① Dietary sodium restriction.
② Diuretics (e.g., Loop).

42
Q

TTT of Nephrotic Syndrome

  • TTT of Hyperlipidemia
A
43
Q

TTT of Nephrotic Syndrome

  • Vaccination
A

All patients should receive pneumococcal vaccination.

44
Q

Done

A

….

Y4R3 - Medicine II 🩺 (35 decks)

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