Nephrotic and Nephritic Syndrome

Question 1

Define nephritic syndrome

Answer 1

A condition involving haematuria, mild to moderate proteinuria, hypertension, oliguria and red cell casts in the urine

Question 2

Symptoms of nephritic syndrome

Answer 2

Haematuria

Oedema (to a lesser extent compared to nephrotic syndrome)

Reduced urine output

Uraemic symptoms (e.g. reduced appetite, fatigue, pruritus, nausea)

Question 3

Signs of nephritic syndrome

Answer 3

Haematuria (either visible or detectable on urinalysis)

Oedema

Hypertension

Oliguria (<300mls/day)

Question 4

Investigations in nephritic syndrome

Answer 4

Urinalysis shows:

Haematuria

Proteinuria (mild)

Red cell casts (distinguishing feature)

Question 5

Management of nephritic syndrome

Answer 5

Treat underlying cause

Dietary changes

ACE inhibitors

Diuretics

Question 6

Definition of nephrotic syndrome

Answer 6

A condition involving loss of significant volumes of protein via the kidneys, resulting in hypoalbuminaemia

Question 7

Aetiologies of nephrotic syndrome

Answer 7

Most commonly minimal change disease

Can be secondary to kidney disease (focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis)

Can be secondary to systemic illness e.g. Henoch Shconlein Purpura, diabetes, infection (HIV, hepatitis, malaria)

Question 8

Clinical features of nephrotic syndrome

Answer 8

Frothy urine

Generalised oedema

Pallor

Question 9

Pathophysiology of nephrotic syndrome

Answer 9

Basement membrane in glomerulus becomes highly permeable to protein, allowing proteins to leak from the blood into the urine

Question 10

Classic triad of nephrotic syndrome

Answer 10

Low serum albumin

High urine protein content (>3+ protein on urine dip)

Oedema

Question 11

Features of nephrotic syndrome

Answer 11

Deranged lipid profile

High blood pressure

Hyper-coagulability, with an increased tendency to form clots

Question 12

Management of nephrotic syndrome

Answer 12

Experienced paediatrician with specialist renal input

High dose steroids e..g prednisolone

Low salt diet

Diuretics may be used to treat oedema

Albumin infusions may be required in severe hypoalbuminaemia

Antibiotic prophylaxis may be given in severe cases

Question 13

Complications of nephrotic syndrome

Answer 13

Hypovolaemia

Thrombosis

Infection

Acute or chronic renal failure

Relapse

Question 14

Investigations in minimal change disease

Answer 14

Renal biopsy and standard microscopy not usually able to detect any abnormality

Urinalysis will show small molecular weight proteins and hyaline casts

Question 15

Management of minimal change disease

Answer 15

Corticosteroids i.e. prednisolone