Nephrology: Nephrotic Syndrome

Question 1

Nephrotic Syndrome

Answer 1

> 3.5 grams of protein per day

this is the maximum the liver can produced per day

therefore low protein in the blood, which leads to edema from low oncotic pressure

any cause of glomerulonephritis can also cause nephrotic syndrome

the edema of nephrotic syndrome can be anywhere (like around eyes), not just dependent areas like in congestive heart failure

also get hyperlipidemia because low apoproteins, body doesn’t see them and clear them

thrombophilia - loss of coagulation proteins

all the transport protein are down:
iron, cooper, zinc deficiency (healing problems)

Question 2

protein on dipstick

Answer 2

if protein excretion was constant:
1+ = 1 gram per day
2+ = 2 grams per day

but excretion is not constant throughout the day, based on renal function

3 grams in 24 hours = 3+ on dipstick
5 grams in 24 hours = 4+
10 grams in 24 hours = 4+
400kg grams in 24 hours = 4+

once you are nephrotic, it doesn’t matter how nephrotic you are

Question 3

best initial tests for proteinuria

Answer 3

either 24 hour protein

or spot protein/creatinine ratio:

3/1 = 3 grams in 24 hours
2/1 = 2 grams in 24 hours

Question 4

maltese crosses

Answer 4

fat droplets / with proteins from the hyperlipemia/hyperteinemia

Question 5

24 hour protein

Answer 5

very difficult, spot protein/creatinine ratio is best

Question 6

primary renal dz

Answer 6

no systemic manifestations

nil lesion / membranous glomerulonephritis, focal segmental glomerulonephritis, mesangial, membranoproliferative
(all give proteinuria, hyperlipidemia, maltese crosses)

no blood tests

best initial test is urinalysis and protein/creatinine ratio

most accurate diagnosis is with the biopsy

tx: streroids
nil lesion responds very well, focal segmental only responds a little

if do not respond well, add cyclophosphamide or micophenolate

Question 7

nil lesion

Answer 7

most common in children

light microscopy looks normal, electron microscopy shows lesion

NSAIDS (don’t know why)

responds will to steroids

Question 8

membranous

Answer 8

most common in adults

cancers and infections

NSAIDs

hepatitis

Question 9

focal segmental

Answer 9

HIV and intravenous drugs like heroin

must biopsy

does not respond well to steroids

Question 10

membranoproliferative

Answer 10

chonic infections, chronic hepatitis

ribivarin + interferon work when hepatitis

dypridamole and aspirin also work (platelets must be leading to the problem)