Nephrotic and nephritis syndrome Flashcards
Definition: Nephritis
Inflammation of the kidneys
What are nephritic and nephrotic syndromes?
Groups of renal symptoms due to a certain histopathology without specifying the underlying cause
Describe the histology of nephritic syndrome
GBM disruption by neutrophils releasing inflammatory mediators and cytokines allowing movement of RBCs into the filtrate
Describe the histology of nephrotic syndrome
Podocyte damage, fusion and loss, as well as loss of negative charge in the GBM allows serum proteins to enter the filtrate
What are some clinical features of nephritic syndrome?
- Haematuria/active urinary sediment (RBC and granular casts, proteinuria)
- Oliguria
- Oedema/fluid retenston
- Hypertension
- Acute renal failure
Urinalysis: Nephritic syndrome
Haematuria
Proteinuria of < 3.5g/day
(Also hypertension)
Urinalysis: Mixed nephritic-nephrotic syndrome
Haematuria
Nephrotic-range proteinuria (>3.5g/day)
Urinalysis: Nephrotic syndrome
Heavy proteinuria (>3.5g/day)
Blood tests: Nephrotic syndrome
Hypoalbuminaemia -> Oedema
Hyperlipidaemia -> Lipiduria (Fatty casts)
How does nephrotic syndrome present ?
Pentad:
- Heavy proteinuria (> 3 g/day)
- Hypoalbuminaemia
- Non-dependent oedema, classically periorbital
- Often associated hyperlipidaemia/hypercholesterolaemia
- Lipiduria
What are some complications of nephrotic syndrome?
Protein loss includes:
- Antibodies
- Complement proteins
- Clotting proteins
- Vit D binding proteins
- Thyroid binding globulin
This can cause infection, thrombosis, emboli, vitamin D deficiency and subclinical hypothyroidism
Also volume depletion due to overaggressive use of diuretics causing acute renal failure (ARF)
How is nephrotic syndrome managed?
- Fluid restriction
- Salt restriction
- Diuretics
- ACEi/ARBs
- Consider anticoagulation
