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Paediatrics > Nephrology - Nephrotic syndrome > Flashcards

Nephrology - Nephrotic syndrome Flashcards

1
Q

How much blood do the kidneys recieve?

A

25% of cardiac output

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2
Q

How does GFR differ between neonates and children?

A
  • 20-30ml/min/1.73m² in neonate
  • 90-120ml/minute/1.73m² by age 2 (same as adults)
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3
Q

What are the five functions of the kidneys?

A
  • Waste handling
  • Water handling
  • Salt balance
  • Acid base control
  • Endocrine (RBC/BP/Bone health)
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4
Q

What are the components of the glomerular filtration barrier?

A
  • Endothelial cells
  • Glomerular filtration membrane
  • Podocytes
  • Mesangial cells
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5
Q

What does proteinuria signify?

A

Glomerular injury

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6
Q

What leans towards nephritic syndrome?

A
  • Increasing haematuria
  • Intravascular overload
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7
Q

What leans toward nephrotic syndrome?

A
  • Increasing proteinuria
  • Intravascular depletion
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8
Q

Some causes of idiopathic glomerulopathy

A
  • Minimal change disease
  • Focal segmental glomerulosclerosis (FSGS)
  • Membranoproliferative glomerulonephritis (MPGN)
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9
Q

Some causes of acquired glomerulopathy

A
  • Henoch-Schonlein purpura (HSP)
  • IgA
  • Lupus
  • Post-infectious
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10
Q

Some causes of congenital glomerulopathy

A
  • Alport syndrome
  • Thin basement membrane disease
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11
Q

What is the definition of nephrotic syndrome?

A

Nephrotic range proteinuria with hypoalbuninaemia and oedema

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12
Q

Why does oedema occur in nephrotic syndrome?

A
  • Starling’s forces
  • Osmotic vs hydrostatic
  • Protein is a magnet to water
  • Leakage of protein into 3rd space leads to osmotic forces
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13
Q

How is proteinuria tested for?

A
  • Dipstix
    • ≥ 3+ usually abnormal
  • Protein Creatinine Ratio (practical)
    • Early morning urine is best
  • 24hr urine collection (gold standard)
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14
Q

Give the values for normal and nephotic range for protein creatinine ratio

A
  • normal: Pr:CR ratio <20mg/mmol
  • nephrotic range: >250mg/mmol
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15
Q

Give the values for normal and nephrotic range for 24 hour urine collection

A
  • Normal <60mg/m²/24hrs
  • Nephrotic range>1g/m²/24hrs
    • Adults >3.5g/24hrs
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16
Q

How is nephrotic syndrome diagnosed?

A
  • Oedema
  • Proteinuria
  • Bloods
    • Abumin low 12mg/dl (n>32)
    • Normal creatinine
17
Q

What type of nephrotic syndrome is most common in children?

A

Minimal change disease

18
Q

Epidemiology of minimal change syndrome

A
  • M:F = 2:1
  • Arab countries, India vs Caucasians = 7:1
  • Diagnosis by trial of treatment
19
Q

Typical features of minimal change disease

A
  • Age (2-5yrs)
  • Normal blood pressure
  • Resolving microscopic haematuria
  • Normal renal function
20
Q

Atypical features of minimal change disease

A
  • Suggestions of autoimmune disease
  • Abnormal renal function
  • Steroid resistance
21
Q

If atypical features of minimal change disease are present what investigation should be considered?

A

Renal biopsy

22
Q

Treatment for nephrotic syndrome

A
  • If typical features then 8 week course of prednisolone
  • Frequent relapses are managed with increased or longer term immune supression
23
Q

Side effects from glucocorticoids

A

(Cushing’s syndrome)

  • hypertension
  • hyperglycaemia
  • personality changes
  • increased susceptibility to infection (review varicella status and give pneumococcal vaccination)
  • growth disturbance
24
Q

What is the spectrum of idiopathic nephrotic syndrome in childhood?

A
  • Non-relapsing
  • Infrequently relapsing
  • Frequently relapsing
  • Steroid dependent
  • Steroid resistant
25
Q

Causes of steroid resistant nephrotic syndrome

A
  • Acquired
    • Focal Segmental Glomeruloscerosis (FSGS)
  • Congenital
    • Present before 3 months of age
    • Mutations in nephrin / podocin genes
    • Podocyte loss
26
Q

Pathology behind Focal Segmental Glomeruloscerosis (FSGS)

A
  • Podocyte loss
  • Progressive inflammation and sclerosis

Paediatrics (38 decks)

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