L33 Nephrotic Syndrome

Question 1

How does nephrotic syndrome present?

Answer 1

With swollen ankles - other cases could be heart failure or DVT (if in one leg).

Question 2

What are possible causes of nephrotic syndrome?

Answer 2

Cause of nephrotic syndrome: (not an exhaustive list)
• minimal change disease (children) - may present with puffy eyes. Classically do not present with swollen ankles as the tissues are very tight. Rarely do a biopsy as this is the most likely cause, there are not many more. Treat with steroids.
In adults - biopsy the kidney as there are different causes with different treatments:
• membranous nephropathy
• focal segmental glomerulosclerosis
• Diabetes
Amyloid

Question 3

What symptoms are found in nephrotic syndrome?

Answer 3

Nephrotic syndrome you need:
- High protein in the urine - proteinuria
- Low serum protein (hypalbuminaemia)
- Oedema
Hypercholesterolaemia - the pathophysiology is unknown, this increases CVD risk

Question 4

What is the aetiology of nephrotic syndrome?

Answer 4

In nephrotic syndrome the podocytes become damaged and become fused. They are no longer discrete entities. This means albumin and other substances are passed across and lost in the urine. Urinary albumin level increase and serum albumin levels decrease. The patient therefore may have swelling of the ankles due to proteinuria. You therefore need to do blood tests and urine sample.