Nephrotic and Nephritic Syndrome (Selby) Flashcards
if serum albumin is normal in setting of nephrotic range proteinuria
then patient does NOT have nephrotic syndrome
they have nephrotic range proteinuria
this may be secondary FSGS
Nephrotic syndrome
>3.5 g/day of proteinuria hypoalbuminemia peripheral edema hyperlipidemia lipiduria
Nephrotic syndrome complication: edema
low albumin but more likely due to Na retention
increased TBW and Na
Nephrotic syndrome complication: hyperlipidemia
we don’t know why
low oncotic pressure stimulates hepatic lipoprotein synthesis
Nephrotic syndrome complication: infection
urinary loss of IgG
sometimes have to supplement with IVIG
Nephrotic syndrome complication: thrombosis
not fully understood
high risk when albumin <2.0 or 2.5
urinary loss of antithrombolytic factors
increased levels of procoagulation factors
thrombo-embolism in nephrotic patients, who is in high risk
serum albumin <20
clinical hypovolemia
bed rest/recurrent illness
membranous nephropathy
Nephrotic syndrome complication: vit D deficiency
urinary loss of Vit D binding protein
Nephrotic syndrome complication: anemia
loss of transferrin and EPO
clinical presentation of Nephrotic Syndrome
new onset HTN
new onset edema(severe anasarca or SoB)
proteinuria
lipiduria
hyperlipidemia
minimal hematuria
may have renal failure
Nephrotic syndrome DDx
Diabetic nephropathy
MCD
FSGS
Membranous nephropathy
Monoclonal disease related (multiple myeloma, amyloidosis, MIDD)
Nephrotic syndrome management: edema
dietary sodium restriction
diuretics
Nephrotic syndrome management: proteinuria
lower BP
ACEi/ARB
alternative antiproteinuric medications (CCB, aldosterone ant, renin inhibotirs)
Nephrotic syndrome management: hyperlipidemia
statins
Nephrotic syndrome management: thrombosis
heparin or warfarin
Nephrotic syndrome management: infection
IVIG
Nephrotic syndrome management: Vit D deficiency
Vit D supplement
Nephritic Syndrome definition
Proteinuria <3.5g/day
hematuria
HTN
renal failure common
Nephritic syndrome usually has
active urinary sediment contrary to the nephrotic syndrome which has ‘bland’ urinary sediment
clinical presentation of nephritic syndrome
new onset HTN
new onset hematuria (microscopic or gross)
AKI (severe cases may progress to RPGN)
proteinuria (<3.5 g/day w/foamy urine)
have edema but less severe than nephrotic
Nephritic DDx
IgA Nephropathy
Thin basement membrane
alport
MPGN
Lupus
Anti-GBM (goodpasture)
ANCA
cryoglobulinemia
TMA
PIGN (PSGN)
endocarditis
low C3
activation of complement
low C3 and C4
activation of classical pathway
is complement useful in nephritic
very, only a few diseases lead to loss of complement
