Nephrotic disease

Question 1

What is nephrotic syndrome?

Answer 1

Nephrotic syndrome is characterized by the tetrad of

• edema
• hypoalbuminemia (<3.0 g/dL)
• heavy proteinuria (generally >3.5 g/day)
• hyperlipidemia

Question 2

How is nephrotic syndrome diagnosed?

Answer 2

-renal biopsy

Question 3

Differential diagnosis for proteinuria in pregnancy?

Answer 3

• Hypertensive spectrum
• Systemic Lupus erythematosus
• Diabetes

Question 4

How do you assess proteinuria in pregnancy?

Answer 4

24 hour urine protein and creatinine clearance

Protein:creatinine

Question 5

What complications may occur during pregnancy in a patient with nephrotic syndrome?

Answer 5

Pregnancy outcomes are generally good in the absence of hypertension and renal impairment.

• Worsening renal dysfunction
• Increases risk for hypertension in the pregnancy

Question 6

How is edema managed in patients with nephrotic syndrome?

Answer 6

Furosemide

_____________________________ give the following if hypertension occurs:
Nifedipine (increases GFR and renal plasma flow) if hypertension occurs in pregnancy and ACE-I in the postpartum period (ACE-I decreases efferent arteriole pressure therefore decreases intraglomerular pressure)

Question 7

How is edema managed in patients with nephrotic syndrome in pregnancy?

Answer 7

salt restriction (with diuretics reserved for intractable cases of edema only)

Question 8

How does nephrotic syndrome impact pregnancy risk?

Answer 8

Increase risk for hypertension